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We studied the security practices of a diverse set of Internet of Things (IoT) devices with different architectures. We found vulnerabilities that can be exploited to launch novel attacks. The real-world implications of IoT attacks show the risks associated with these new technologies, and can help us articulate the need for better security practices.

Although leukocyte telomere length (TL) shortens over the lifespan and is associated with diseases of aging, little is known about the relationships between TL, memory, and brain structure. Sixty-nine functionally normal older adults (mean age = 71.7) were assessed at 2 time points (mean interval = 2.9 years). Linear mixed models assessed relationships between TL and hippocampal volume, fractional anisotropy, and mean diffusivity (MD) of the fornix and verbal and visual episodic memory. Unstandardized coefficients are reported in the following, and p values are not corrected for multiple comparisons. A negative baseline trend was observed between TL and fornix MD (b = -0.01, p = 0.06), but no other cross-sectional associations were significant (ps > 0.16). Greater TL shortening at follow-up was associated with greater hippocampal volume loss (b = 27.09, p < 0.001), even after controlling for global volume loss (b = 10.83, p = 0.002). Greater telomere attrition was also associated with larger increases in fornix MD (b = -0.01, p = 0.012) and decreases in fornix fractional anisotropy (b = 0.004, p = 0.002). TL was not associated with changes in episodic memory (ps > 0.23). These relationships may reflect neurobiological influences that affect both TL and brain structure, as well as the effect of TL on brain aging via mechanisms such as cellular senescence and inflammation.

This study aimed to improve the predictive accuracy of the Braden assessment for pressure injury risk in skilled nursing facilities (SNFs) by incorporating real‐world data and training a survival model. A comprehensive analysis of 126 384 SNF stays and 62 253 in‐house pressure injuries was conducted using a large calibrated wound database. This study employed a time‐varying Cox Proportional Hazards model, focusing on variations in Braden scores, demographic data and the history of pressure injuries. Feature selection was executed through a forward‐backward process to identify significant predictive factors. The study found that sensory and moisture Braden subscores were minimally contributive and were consequently discarded. The most significant predictors of increased pressure injury risk were identified as a recent (within 21 days) decrease in Braden score, low subscores in nutrition, friction and activity, and a history of pressure injuries. The model demonstrated a 10.4% increase in predictive accuracy compared with traditional Braden scores, indicating a significant improvement. The study suggests that disaggregating Braden scores and incorporating detailed wound histories and demographic data can substantially enhance the accuracy of pressure injury risk assessments in SNFs. This approach aligns with the evolving trend towards more personalized and detailed patient care. These findings propose a new direction in pressure injury risk assessment, potentially leading to more effective and individualized care strategies in SNFs. The study highlights the value of large‐scale data in wound care, suggesting its potential to enhance quantitative approaches for pressure injury risk assessment and supporting more accurate, data‐driven clinical decision‐making. [ABSTRACT FROM AUTHOR]

This article explores the application of actor‐network theory (ANT) to the nursing profession, proposing a novel perspective in understanding nursing in the context of modern digital healthcare. Traditional grand nursing theories, while foundational, often fail to encapsulate the dynamic and complex nature of nursing, particularly in an era of rapid technological advancements and shifting societal dynamics. ANT, with its emphasis on the relationships between human and nonhuman actors, offers a framework to understand nursing beyond traditional paradigms. This article makes two key arguments: first, that nursing can be viewed as a highly organised social assemblage, where both human (nurses, patients and policymakers) and nonhuman actors (technologies, medical equipment, institutional policies) play a crucial role, and second, that ANT can be used to enhance existing nursing theory to better understand the role of technology in nursing practice. The article considers how ANT can provide a more holistic and adaptable model for describing the nursing profession, particularly in an era where technology plays an integral role in healthcare delivery. It discusses the implications of viewing nursing through ANT, highlighting the need for nursing education and practice to adapt to the interconnected and technologically advanced nature of modern healthcare. The article also acknowledges the limitations of ANT, particularly its potential oversimplification of the complex ethical dimensions inherent in nursing and its focus on observable phenomena. [ABSTRACT FROM AUTHOR]

ObjectiveAging is often associated with declines in episodic memory. Reliable tracking of memory requires assessment instruments that are stable over time to better understand changes potentially attributable to neurodegenerative disease. While prior studies support the test-retest reliability of memory instruments over brief intervals, follow-up testing in clinical settings typically occurs at least one-year later. The present study evaluated the long-term test-retest reliability of the California Verbal Learning Test - second edition (CVLT-2), a widely used measure of episodic learning and memory.MethodOne hundred and fifty seven healthy older adults (mean age = 68.47 years; education = 17.28 years) underwent repeat assessment at an average of 1.30 years apart. Participants underwent repeat assessment using either parallel or alternate forms at follow-up. We utilized a standardized regression-based (SRB) approach to determine statistically significant changes in test scores over time.ResultsThis study revealed modest 1-year test-retest correlation coefficients for the primary CVLT-2 measures (range = .57-.69) Results of SRB formulae are provided to assist clinicians with defining clinically relevant cognitive change on the CVLT-2 while controlling for confounding factors.ConclusionsFindings from this study support repeat test administration of the CVLT-2 over longer periods, and may enhance its applicability in determining longitudinal change in memory performance.

Objective: To examine the impact of genetic, inflammatory, cardiovascular, lifestyle, and neuroanatomical factors on cognitive processing speed (CPS) change over time in functionally intact older adults. Methods: This observational study conducted over two time points, included 120 community dwelling cognitively normal older adults between the ages of 60 and 80 from the University of California San Francisco Memory and Aging Center. Participants were followed with composite measures of CPS, calculated based on norms for 20-30 year-olds. Variables of interest were AD risk genes (APOE, CR1), markers of inflammation (interleukin 6) and cardiovascular health (BMI, LDL, HDL, mean arterial pressure, fasting insulin), self-reported physical activity, and corpus callosum (CC) volumes. The sample was divided into three groups: 17 "resilient-agers" with fast and stable processing speed; 56 "average-agers" with average and stable processing speed; and 47 "sub-agers" with average baseline speed who were slower at follow-up. Results: Resilient-agers had larger baseline CC volumes than sub-agers (p < 0.05). Resilient-agers displayed lower levels of interleukin-6 (IL-6) and insulin (ps < 0.05) than sub-agers, and reported more physical activity than both average- and sub-agers (ps < 0.01). In a multinomial logistic regression, physical activity and IL-6 predicted average- and sub-ager groups. Resilient-agers displayed a higher frequency of APOE e4 and CR1 AA/AG alleles. Conclusion: Robust and stable CPS is associated with larger baseline CC volumes, lower levels of inflammation and insulin, and greater self-reported physical activity. These findings highlight the relevance of neuroanatomical, biological, and lifestyle factors in the identification and prediction of heterogeneous cognitive aging change over time.

Ankle Brachial Pressure Index (ABPI) measurement has long been considered the gold standard of vascular assessment for people with lower limb ulceration. Despite this, only around 15% of patients in the United Kingdom who require an ABPI measurement undergo the assessment. The Lanarkshire Oximetry Index (LOI) is a cheaper and arguably more accessible approach to vascular assessment and was initially proposed as an alternative to the ABPI in 2000. No synthesis of evidence related to the LOI has been performed since its introduction into the literature. Primary studies were sought to determine the clinimetric properties of the LOI and its level of agreement with ABPI assessments. Systematic searches of MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, BNI, ProQuest Health and Medicine, Science Direct, Google Scholar and the British Library (online search) were conducted. Reference lists of identified studies were also reviewed to identify additional studies. Three primary studies met the inclusion criteria, reporting data from 307 patients and 584 limbs assessed using both the LOI and ABPI. All three studies reported fair to moderate kappa values for interrater reliability (κ = 0.290–0.747) and statistically significant positive correlation coefficients (r = 0.37, p < 0.001 in two studies) between the LOI and ABPI. The combined data from the three studies indicated a sensitivity of 52% (41.78–62.1, 95% confidence interval [CI]) and specificity of 96.08% (93.4–97.9, 95% CI) for the LOI using the ABPI as a reference. Additional data are required to indicate the safety of the LOI in practice. Data are also required to determine if the LOI is more acceptable to clinicians compared to the ABPI and whether there are any barriers/enablers to its implementation in practice. Given the relatively low specificity of the LOI, it may be beneficial to combine measurement of the LOI with a subjective clinical risk assessment tool to improve the sensitivity of this alternative approach to vascular assessment. [ABSTRACT FROM AUTHOR]

Executive functions are often considered lynchpin "frontal lobe tasks", despite accumulating evidence that a broad network of anterior and posterior brain structures supports them. Using a latent variable modelling approach, we assessed whether prefrontal grey matter volumes independently predict executive function performance when statistically differentiated from global atrophy and individual non-frontal lobar volume contributions. We further examined whether fronto-parietal white matter microstructure underlies and independently contributes to executive functions. We developed a latent variable model to decompose lobar grey matter volumes into a global grey matter factor and specific lobar volumes (i.e. prefrontal, parietal, temporal, occipital) that were independent of global grey matter. We then added mean fractional anisotropy (FA) for the superior longitudinal fasciculus (dorsal portion), corpus callosum, and cingulum bundle (dorsal portion) to models that included grey matter volumes related to cognitive variables in previous analyses. Results suggested that the 2-factor model (shifting/inhibition, updating/working memory) plus an information processing speed factor best explained our executive function data in a sample of 202 community dwelling older adults, and was selected as the base measurement model for further analyses. Global grey matter was related to the executive function and speed variables in all four lobar models, but independent contributions of the frontal lobes were not significant. In contrast, when assessing the effect of white matter microstructure, cingulum FA made significant independent contributions to all three executive function and speed variables and corpus callosum FA was independently related to shifting/inhibition and speed. Findings from the current study indicate that while prefrontal grey matter volumes are significantly associated with cognitive neuroscience measures of shifting/inhibition and working memory in healthy older adults, they do not independently predict executive function when statistically isolated from global atrophy and individual non-frontal lobar volume contributions. In contrast, better microstructure of fronto-parietal white matter, namely the corpus callosum and cingulum, continued to predict executive functions after accounting for global grey matter atrophy. These findings contribute to a growing literature suggesting that prefrontal contributions to executive functions cannot be viewed in isolation from more distributed grey and white matter effects in a healthy older adult cohort.

IntroductionMCP-1 and eotaxin-1 are encoded on chromosome 17 and have been shown to reduce hippocampal neurogenesis in mice. We investigated whether these chemokines selectively associate with memory in individuals with mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia.MethodsMCP-1 and eotaxin-1 were assayed in controls, MCI, and AD dementia patients with varying phenotypes (n = 171). A subset of 55 individuals had magnetic resonance imaging (MRI) scans available. Composite scores for cognitive variables were created, and medial temporal lobe volumes were obtained.ResultsAn interaction was noted between MCP-1 and eotaxin-1, such that deleterious associations with memory were seen when both chemokines were elevated. These associations remained significant after adding APOE genotype and comparison (non-chromosome 17) chemokines into the model. These chemokines predicted left medial temporal lobe volume and were not related to other cognitive domains.DiscussionThese results suggest a potentially selective role for MCP-1 and eotaxin-1 in memory dysfunction in the context of varied MCI and AD dementia phenotypes.

This program evaluation examined the feasibility, acceptability, and preliminary effects of an individualized coaching program to help older Veterans use VA mental health mobile apps to address mental health and well-being goals. The program delivers individual technical and clinical support to facilitate the use of mobile devices and VA apps. Participants completed assessments of mobile device proficiency, app use frequency, app comfort, quality of life, and mental health symptoms (completed by a subset, n = 11) pre- and post-participation. Of 24 enrollees, 17 completed the program and received an average of 7.58 (SD = 2.87) sessions including the initial assessment. Mobile device proficiency (t (16) = −3.80, p =.002) and number of days/week apps were used (t (16) = −2.34, p =.032) increased significantly from pre- to post-participation. Depressive and anxiety scores decreased significantly (t (10) = 3.16, p =.010; t (10) = 3.29, p =.008) among the subset completing those measures. Overall satisfaction was high; 100% reported they would recommend the program. Findings suggest the program is feasible, highly acceptable, and increases mobile device proficiency and use of apps. Coaching programs can equip older adults with the skills to use mental health apps. [ABSTRACT FROM AUTHOR]

Objective: This article highlights challenges of wound care in low resource settings, considering opportunities for frugal innovation and our experiences while creating virtual wound care clinics across two global communities. In addition, we will discuss four real cases presented within the virtual clinics. An adaptation of the widely accepted tissues, infection, moisture, edge, regeneration and repair of tissue, and social factors (TIMERS) wound assessment is also proposed with considerations for low-resource settings. Method: From March to December 2021 the University of Salford engaged in a virtual wound clinic initiative with colleagues in Fort Portal Regional Referral Hospital. Results: The clinics provided opportunities for professional and academic development of students on postgraduate tissue viability module in Salford, while empowering nurses and midwives in Uganda in taking their place at the centre of multidisciplinary teams in care delivery Furthermore, it created links between the university and clinicians in Uganda to develop the delivery of evidence-based wound management. Throughout this period, challenges associated with low resources were highlighted and, in some cases, innovative approaches to managing wound care were adopted to account for this. Conclusions: The development and delivery of the virtual wound care clinics between the University of Salford and Fort Portal Regional Referral Hospital provided an opportunity for reflection on practice. This led to development of a Fit4purpose wound dressing, revision of evidence-based guidelines, deeper understanding of the scarcity of essential items and frugal practice, and examination of skin tone bias in the signs and symptoms of wound infection in patients with dark skin tones. [ABSTRACT FROM AUTHOR]

Introduction: Tissue viability skills are essential for nurses, but education on this in undergraduate programmes can be inadequate. After approval of the Future Nurse curriculum in 2019, a small team of staff at the University of Salford developed a Getting Wound Care Right week to improve students' knowledge and clinical skills. Methods: To evaluate the week, the 250 students who had participated in all activities were invited 6 months after the week to contribute a 250-word reflection for a case series. The aim of this was to understand the impact of the week on participants' knowledge, skills and confidence in caring for patients with wounds and whether it had sparked interest in further learning. Results: Four students contributed reflections, which were overwhelmingly positive. They described the knowledge attained, which included that on anatomy and physiology of the skin and wound healing, evidence-based assessment, treatment and management of wounds, and the impact of wounds on patients' quality of life. Skills gained included those in categorisation of wounds, wound assessment and pressure redistribution when seated. Responses on the impact on clinical practice focused on the importance of multidisciplinary working within wound care, seating provision for pressure ulcer prevention and management, and dressing selection. Negative comments related to students realising that clinical practice could be improved rather than indications that the format is ineffective or inappropriate. Limitations of the evaluation included the small number of participants and a lack of responses from every field of practice. Conclusions: The Getting Wound Care Right week format is a viable approach to meeting Future Nurse curriculum requirements. The approach could be enhanced by a greater emphasis on the relevance of wound care teaching to children and young people's nursing students. The week improved students' clinical confidence on placements when caring for patients with wounds. Further robust evaluation of the module is needed to confirm the findings of this initial evaluation. [ABSTRACT FROM AUTHOR]

The European Wound Management Association (EWMA) 2020 Level Seven curriculum recommends the provision of training on sharp debridement, primarily targeting specialist practitioners in wound care. Given the current lack of regulation for wound specialists in the UK, the quality and fidelity of training play a crucial role in health professionals' confidence when performing sharp debridement. Consequently, it is vital that training aids and methods accurately represent the realities of this procedure. Existing literature outlines training approaches using animal tissue or grapefruit models for sharp debridement. The University of Salford has developed a new simulation aid to teach tissue viability students about sharp debridement. This article details the development process and the creation of this innovative training aid designed to support sharp debridement education. The proposed simulation aid enables accurate representation of various wound tissue types requiring debridement in clinical settings, while eliminating the production of organic waste and the need for animal products, which may be objectionable to some learners. [ABSTRACT FROM AUTHOR]