Search Results (38)

Background: The U.S. Medicare Annual Wellness Visit (AWV) offers a structured opportunity for cognitive screening and personalized prevention planning among older adults. Yet, implementation of AWVs, particularly for individuals with cognitive impairment, remains inconsistent across primary care or other diverse care settings. Methods: We conducted a scoping review using the Consolidated Framework for Implementation Research (CFIR) to explore multilevel factors influencing the implementation of the Medicare AWV’s cognitive screening component, with a focus on how these processes support the detection and management of cognitive impairment among older adults. We searched four databases and screened peer-reviewed studies published between 2011 and March 2025. Searches were conducted in Ovid MEDLINE, PubMed, EBSCOhost, and CINAHL databases. The initial search was completed on 3 January 2024 and updated monthly through 30 March 2025. All retrieved citations were imported into EndNote 21, where duplicates were removed. We screened titles and abstracts for relevance using the predefined inclusion criteria. Full-text articles were then reviewed and scored as either relevant (1) or not relevant (0). Discrepancies were resolved through consensus discussions. To assess the methodological quality of the included studies, we used the Joanna Briggs Institute critical appraisal tools appropriate to each study design. These tools evaluate rigor, trustworthiness, relevance, and risk of bias. We extracted the following data from each included study: Author(s), year, title, and journal; Study type and design; Data collection methods and setting; Sample size and population characteristics; Outcome measures; Intervention details (AWV delivery context); and Reported facilitators, barriers, and outcomes related to AWV implementation. The first two authors independently coded and synthesized all relevant data using a table created in Microsoft Excel. The CFIR guided our data analysis, thematizing our findings into facilitators and barriers across its five domains, viz: (1) Intervention Characteristics, (2) Outer Setting, (3) Inner Setting, (4) Characteristics of Individuals, and (5) Implementation Process. Results: Among 19 included studies, most used quantitative designs and secondary data. Our CFIR-based synthesis revealed that AWV implementation is shaped by interdependent factors across five domains. Key facilitators included AWV adaptability, Electronic Health Record (EHR) integration, team-based workflows, policy alignment (e.g., Accountable Care Organization participation), and provider confidence. Barriers included vague Centers for Medicare and Medicaid Services (CMS) guidance, limited reimbursement, staffing shortages, workflow misalignment, and provider discomfort with cognitive screening. Implementation strategies were often poorly defined or inconsistently applied. Conclusions: Effective AWV delivery for older adults with cognitive impairment requires more than sound policy and intervention design; it demands organizational readiness, structured implementation, and engaged providers. Tailored training, leadership support, and integrated infrastructure are essential. These insights are relevant not only for U.S. Medicare but also for global efforts to integrate dementia-sensitive care into primary health systems. Our study has a few limitations that should be acknowledged. First, our scoping review synthesized findings predominantly from quantitative studies, with only two mixed-method studies and no studies using strictly qualitative methodologies. Second, few studies disaggregated findings by race, ethnicity, or geography, reducing our ability to assess equity-related outcomes. Moreover, few studies provided sufficient detail on the specific cognitive screening instruments used or on the scope and delivery of educational materials for patients and caregivers, limiting generalizability and implementation insights. Third, grey literature and non-peer-reviewed sources were not included. Fourth, although CFIR provided a comprehensive analytic structure, some studies did not explicitly fit in with our implementation frameworks, which required subjective mapping of findings to CFIR domains and may have introduced classification bias. Additionally, although our review did not quantitatively stratify findings by year, we observed that studies from more recent years were more likely to emphasize implementation facilitators (e.g., use of templates, workflow integration), whereas earlier studies often highlighted systemic barriers such as time constraints and provider unfamiliarity with AWV components. Finally, while our review focused specifically on AWV implementation in the United States, we recognize the value of comparative analysis with international contexts. This work was supported by a grant from the National Institute on Aging, National Institutes of Health (Grant No. 1R01AG083102-01; PIs: Tzeng, Kuo, & Raji). Full article

Background: Tobacco use is disproportionately high in rural areas, contributing to elevated cancer mortality, yet it often goes untreated due to limited access to care, high poverty and uninsured rates, and co-occurring substance use disorders (SUDs). This study explored the utility of using rapid qualitative analysis (RQA) to guide the adaptation of a tobacco-free workplace program (TFWP) in Texas healthcare centers serving adults with SUDs in medically underserved areas. Methods: From September–December 2023 and May–July 2024, we conducted 11 pre-implementation, virtual semi-structured group interviews focused on adapting the TFWP to local contexts (N = 69); 7 with providers (n = 34) and managers (n = 12) and 4 with patients (n = 23) in 6 healthcare centers. Two qualified analysts independently summarized transcripts, using RQA templates of key domains drawn from interview guides to summarize and organize data in matrices, enabling systematic comparison. Results: The main themes identified were minimal organizational tobacco cessation support and practices, and attitudinal barriers, as follows: (1) the need for program materials tailored to local populations; (2) limited tobacco cessation practices and partial policies—staff requested guidance on enhancing tobacco screenings and cessation delivery, and integrating new interventions; (3) contradictory views on treating tobacco use that can inhibit implementation (e.g., wanting to quit yet anxious that quitting would cause SUD relapse); and (4) inadequate environmental supports—staff requested treating tobacco-use training, patients group cessation counseling; both requested nicotine replacement therapy. Conclusions: RQA identified key areas requiring capacity development through participants’ willingness to adopt the following adaptations: program content (e.g., trainings and tailored educational materials), delivery methods/systems (e.g., adopting additional tobacco care interventions) and implementation strategies (e.g., integrating tobacco cessation practices into routine care) critical to optimizing TFWP fit and implementation. The study findings can inform timely formative evaluation processes to design and tailor similar intervention efforts by addressing site-specific needs and implementation barriers to enhance program uptake. Full article

Fragility fractures of the pelvis (FFPs) are common in elderly patients, particularly those with osteoporosis. FFPs can be associated with high mortality, morbidity, and functional decline. Known risk factors include being over 80 years old and delays in surgical intervention when this is required. While the role of surgery in FFPs remains less defined than in proximal femoral fractures in the elderly, studies indicate that surgical fixation offers improved survival and functional outcomes. Similarly, the choice of fixation method, whether posterior or anterior, and their combinations, vary between clinicians. It depends on the fracture type and patient-specific factors, such as bone quality and comorbidities, as well as the surgeon’s experience and the availability of resources. Additionally, orthobiologic adjuncts such as cement augmentation and sacroplasty can enhance the stability of an osteoporotic fracture during surgical intervention. Furthermore, medical treatments for osteoporosis, especially the use of teriparatide, have demonstrated beneficial effects in reducing fractures and promoting healing of the FFPs. Return to pre-injury activities is often limited, with independence rates remaining low at mid-term follow-up. Factors that influence clinical outcomes include fracture type, with Type III and IV fractures generally leading to poorer outcomes, and patient age, functional reserve, and comorbidities. The present tutorial aims to summarise the relevant evidence on all aspects of FFPs, inform an updated management strategy, and provide a template of the reconstruction ladder referring to the most available surgical techniques and treatment methods. Further research, based on large-scale studies, is needed to address the open questions described in this manuscript and refine surgical techniques, as well as determine optimal treatment pathways for this vulnerable patient population. Full article

In brain mapping, structural templates derived from population-specific MRI scans are essential for normalizing individual brains into a common space. This normalization facilitates accurate group comparisons and statistical analyses. Although templates have been developed for various populations, none currently exist for the Saudi population. To our knowledge, this work introduces the first structural brain template constructed and evaluated from a homogeneous subset of T1-weighted MRI scans of 11 healthy Saudi female subjects aged 25 to 30. Our approach combines the symmetric model construction (SMC) method with a covariance-based weighting scheme to mitigate bias caused by over-represented anatomical features. To enhance the quality of the template, we employ a patch-based mean-shift intensity estimation method that improves image sharpness, contrast, and robustness to outliers. Additionally, we implement computational optimizations, including parallelization and vectorized operations, to increase processing efficiency. The resulting template exhibits high image quality, characterized by enhanced sharpness, improved tissue contrast, reduced sensitivity to outliers, and minimized anatomical bias. This Saudi-specific brain template addresses a critical gap in neuroimaging resources and lays a reliable foundation for future studies on brain structure and function in this population. Full article

Eurasian otters, as apex predators in freshwater ecosystems, are crucial to maintaining nutrient cycling and habitat stability. Although Eurasian otters prefer unaltered natural habitats, their adaptive and opportunistic behavior allows them to occupy suboptimal environments, including urbanized areas. As urbanization increases, the pressure on apex carnivores like the Eurasian otter will continue to grow. To date, urban stream restoration plans have not used the Eurasian otter as a keystone species, but given their influence across the trophic levels, Eurasian otter-focused restoration plans could enhance otter populations and overall biodiversity in urban areas. Here, we lay out six principles designed as a template for enhancing urban habitats for Eurasian otters as well as biodiversity. The principles (enhancing habitat structure complexity, restoring natural riparian vegetation and habitats, safeguarding water quality, providing native prey species, reducing otter mortality, and promoting positive public perception) are essential for urban ecosystem regeneration focused on Eurasian otters. Although there have been no urban restoration projects specifically tailored toward Eurasian otters, initiatives based on similar principles have been effective in promoting biodiversity and otter presence. Overall, an urban habitat restoration plan focused on Eurasian otters will not just increase otter presence but biodiversity across all trophic levels. Full article

Physiologically based pharmacokinetic (PBPK) modelling for biologics, such as monoclonal antibodies and therapeutic proteins, involves capturing complex processes, including target-mediated drug disposition (TMDD), FcRn-mediated recycling, and tissue-specific distribution. The Simcyp Designer Biologics PBPK Platform Model offers an intuitive and efficient platform for constructing mechanistic PBPK models with pre-defined templates and automated model assembly, reducing manual input and improving reproducibility. This tutorial provides a step-by-step guide to using the platform, highlighting features such as cross-species scaling, population variability simulations, and flexibility for model customization. Practical case studies demonstrate the platform’s capability to streamline workflows, enabling rapid, mechanistic model development to address key questions in biologics drug development. By automating critical processes, this tool enhances decision-making in translational research, optimizing the modelling and simulation of large molecules across discovery and clinical stages. Full article

Even though COVID-19 is no longer the primary focus of the global scientific community, its high mutation rate (nearly 30 substitutions per year) poses a threat of a potential comeback. Effective vaccines have been developed and administered to the population, ending the pandemic. Nonetheless, reinfection by newly emerging subvariants, particularly the latest JN.1 strain, remains common. The rapid mutation of this virus demands a fast response from the scientific community in case of an emergency. While the immune escape of earlier variants was extensively investigated, one still needs a comprehensive understanding of how specific mutations, especially in the newest subvariants, influence the antigenic escape of the pathogen. Here, we tested comprehensive in silico approaches to identify methods for fast and accurate prediction of antibody neutralization by various mutants. As a benchmark, we modeled the complexes of the murine antibody 2B04, which neutralizes infection by preventing the SARS-CoV-2 spike glycoprotein’s association with angiotensin-converting enzyme (ACE2). Complexes with the wild-type, B.1.1.7 Alpha, and B.1.427/429 Epsilon SARS-CoV-2 variants were used as positive controls, while complexes with the B.1.351 Beta, P.1 Gamma, B.1.617.2 Delta, B.1.617.1 Kappa, BA.1 Omicron, and the newest JN.1 Omicron variants were used as decoys. Three essentially different algorithms were employed: forced placement based on a template, followed by two steps of extended molecular dynamics simulations; protein–protein docking utilizing PIPER (an FFT-based method extended for use with pairwise interaction potentials); and the AlphaFold 3.0 model for complex structure prediction. Homology modeling was used to assess the 3D structure of the newly emerged JN.1 Omicron subvariant, whose crystallographic structure is not yet available in the Protein Database. After a careful comparison of these three approaches, we were able to identify the pros and cons of each method. Protein–protein docking yielded two false-positive results, while manual placement reinforced by molecular dynamics produced one false positive and one false negative. In contrast, AlphaFold resulted in only one doubtful result and a higher overall accuracy-to-time ratio. The reasons for inaccuracies and potential pitfalls of various approaches are carefully explained. In addition to a comparative analysis of methods, some mechanisms of immune escape are elucidated herein. This provides a critical foundation for improving the predictive accuracy of vaccine efficacy against new viral subvariants, introducing accurate methodologies, and pinpointing potential challenges. Full article

Background: Older adults in residential aged care facilities (RACFs) experience disproportionate levels of poor oral health relative to other groups in the general population, affecting their physical and mental wellbeing. The Oral Health Assessment Tool (OHAT) is a validated and widely used dental assessment tool; however, recent systematic reviews have identified shortcomings with respect to its measurement properties. Objective: The objective of this protocol is to provide a detailed overview of a multidisciplinary qualitative study that aims to (a) co-design and develop a modified OHAT for RACFs and (b) inform the development of an OHAT training package and implementation strategies. Methods: This study will utilize a co-design methodology with aged care residents, caregivers, staff members, and health professionals. The co-design workshops will: (1) investigate the barriers to and enablers of optimal oral healthcare in RACFs; and (2) co-design a modified version of the Oral Health Assessment Tool and a referral to treatment pathway that is appropriate for use in RACFs. The co-design workshops will facilitate group discussion and involve interactive activities using, for example, mind mapping and Sticky Notes. Qualitative data (transcripts and artefacts from co-design activities) will be analyzed in NVivo using an inductive codebook thematic analysis, specifically a template analysis. Conclusion: The findings of this study will inform a modified OHAT (M-OHAT), as well as future study phases regarding training and implementation strategies. It is expected that the M-OHAT will have enhanced usability and relevance to RACFs, facilitating the identification of poor oral health and timely referral to dental treatment. Full article

Disordered eating is a significant issue in university student populations. Currently, access to interventions is limited. Online interventions present an innovative way to increase accessibility to treatment for those in need. The current study explored how an online intervention for disordered eating (everyBody) could be modified to suit the needs of university students in Aotearoa New Zealand. Aotearoa New Zealand is a unique cultural context, with an indigenous population that has a high incidence rate of disordered eating, highlighting the need to adapt everyBody to the local context. Individual interviews were conducted with nine students currently at university in Aotearoa New Zealand, aged between 18 and 33 years old (five females, four males). Three first-order themes were identified using template analysis. The themes indicate that participants perceived the programme as acceptable and feasible for use with Aotearoa New Zealand’s university student population. Furthermore, the themes provide insight into potential adaptions to the programme to facilitate engagement and uptake. The suggested changes were largely consistent with previous research on E-therapy design (e.g., content length, therapeutic alliance), and also highlight changes specific to fit Aotearoa New Zealand’s cultural context. The findings have implications for universities and other funders deciding on services for students with disordered eating and eating disorders. Full article

Prion diseases are caused by the disease-specific self-templating infectious conformation of the host-encoded prion protein, PrP^Sc. Prion strains are operationally defined as a heritable phenotype of disease under controlled conditions. One of the hallmark phenotypes of prion strain diversity is tropism within and between tissues. A defining feature of prion strains is the regional distribution of PrP^Sc in the CNS. Additionally, in both natural and experimental prion disease, stark differences in the tropism of prions in secondary lymphoreticular system tissues occur. The mechanism underlying prion tropism is unknown; however, several possible hypotheses have been proposed. Clinical target areas are prion strain-specific populations of neurons within the CNS that are susceptible to neurodegeneration following the replication of prions past a toxic threshold. Alternatively, the switch from a replicative to toxic form of PrP^Sc may drive prion tropism. The normal form of the prion protein, PrP^C, is required for prion formation. More recent evidence suggests that it can mediate prion and prion-like disease neurodegeneration. In vitro systems for prion formation have indicated that cellular cofactors contribute to prion formation. Since these cofactors can be strain specific, this has led to the hypothesis that the distribution of prion formation cofactors can influence prion tropism. Overall, there is evidence to support several mechanisms of prion strain tropism; however, a unified theory has yet to emerge. Full article

(1) Background: Dementia and mild cognitive impairment (MCI) are still underdiagnosed in the general population. Impaired odor identification has been identified as an early marker of MCI and dementia. We aim to investigate whether short tasks, in which simple forms must be assembled from single building blocks based on a template or while considering specific re-strictions, could increase the diagnostic quality of established cognitive screening tests in detecting MCI or dementia. (2) Methods: A brief assembly test, where participants had to assemble simple animal shapes from Lego^® Duplo^® building blocks, the Frontal Assessment Battery, and the Mini-Mental State Exam (MMSE) were administered to a consecutive series of 197 patients (89 with mild dementia, 62 with mild cognitive impairment, and 46 without cognitive impairment) referred for neuropsychological testing. (3) Results: Both participants with dementia and with MCI performed badly in the assembly tasks. The assembly tasks and the Frontal Assessment Battery were substantially correlated. Complementing MMSE scores with the assembly tasks improved the diagnostic accuracy of individuals with dementia and MCI. (4) Conclusions: People with suspected dementia or MCI may already benefit from simple assembly tasks. Although these tests require little additional time, they can notably increase sensitivity for dementia or MCI. Full article

The colour of the butterfly wing serves as an important sexual and species-specific signal. Some species produce structural colouration by developing wing scales with photonic nanoarchitectures. These nanostructures are highly conservative, allowing only a ±10 nm peak wavelength deviation in the reflectance spectra of the blue structural colour in natural Common Blue (Polyommatus icarus) populations. They are promising templates of future artificial photonic materials and can be used in potential applications, too. In this work, we present methodology and infrastructure for breeding laboratory populations of Common Blue as a cost-effective and environmentally friendly source of nanostructures. Our technology enables the production of approximately 7500 wing samples, equivalent to 0.5–1 m² of photonic nanoarchitecture surface within a year in a single custom-made insectarium. To ascertain the reliability of this method, we compared reflectance properties between different populations from distant geographic locations. We also provide genetic background of these populations using microsatellite genotyping. The laboratory population showed genetic erosion, but even after four generations of inbreeding, only minimal shifts in the structural colouration were observed, indicating that wild Common Blue populations may be a reliable source of raw material for photonic surfaces. Full article

Listeria monocytogenes (L.M.) is a gram-positive bacillus with wide distribution in the environment. This bacterium contaminates water sources and food products and can be transmitted to the human population. The infection caused by L.M. is called listeriosis and is common in pregnant women, immune-deficient patients, and older adults. Based on the released statistics, listeriosis has a high rate of hospitalization and mortality; thus, rapid and timely detection of food contamination and listeriosis cases is necessary. During the last few decades, biosensors have been used for the detection and monitoring of varied bacteria species. These devices are detection platforms with great sensitivity and low detection limits. Among different types of biosensors, electrochemical biosensors have a high capability to circumvent several drawbacks associated with the application of conventional laboratory techniques. In this review article, different electrochemical biosensor types used for the detection of listeriosis were discussed in terms of actuators, bioreceptors, specific working electrodes, and signal amplification. We hope that this review will facilitate researchers to access a complete and comprehensive template for pathogen detection based on the different formats of electrochemical biosensors. Full article

India, with the world’s largest cattle population, is a leading producer of milk, and claims to be self-sufficient for dairy production. However, such an important component for nutritional security has been reported to be adulterated by 68% by the national food safety agency. This study challenges the basic claim of self-sufficiency in terms of milk production and food security for milk and milk products. A novel model for studying milk safety is presented, which evaluates the prevailing conditions in the Andaman and Nicobar Islands (A&N), India. There are no comprehensive data nor studies available for this region. The assessment of the pillars of food security found that with the present population load, there is an annual deficit of 25673.7 MT of fluid milk in the A&N Islands. The study found that the average herd size is 1.9, with about 26.9% of the animals rearing desi (non-descriptive) cattle, characterized by low production levels of 3.95 L/day and with gene frequency of 16.48% for the A1 allele. None of the milk samples were found to be positive for antibiotic (tetracycline and aminoglycoside) residues. However, 4% of the milk samples were found to be positive for the aflatoxin residues above the permitted MRL. The KAP study shows that awareness regarding clean milk production, antimicrobial residues, withdrawal timings, aflatoxins, etc. is poor/highly limited among the farmers of the region. The output may act as a referral study and a template for future studies for the assessment of product-specific food security. Our findings highlight the limitations of the present approach and the need for additional data, using a wider range of research techniques for assessing dairy. Whilst not definitive, it aims to highlight those factors which are considered crucial to an understanding of contemporary milk safety controls. Full article

Extreme disasters, defined as low-probability–high-consequences events, are often due to cascading effects combined to amplifying environmental factors. While such a risk complexity is commonly addressed by the modeling of site-specific multi-risk scenarios, there exists no harmonized approach that considers the full space of possibilities, based on the general relationships between the environment and the perils that populate it. In this article, I define the concept of a digital template for multi-risk R&D and prototyping in the Generic Multi-Risk (GenMR) framework. This digital template consists of a virtual natural environment where different perils may occur. They are geological (earthquakes, landslides, volcanic eruptions), hydrological (river floods, storm surges), meteorological (windstorms, heavy rains), and extraterrestrial (asteroid impacts). Both geological and hydrological perils depend on the characteristics of the natural environment, here defined by two environmental layers: topography and soil. Environmental objects, which alter the layers, are also defined. They are here geomorphic structures linked to some peril source characteristics. Hazard intensity footprints are then generated for primary, secondary, and tertiary perils. The role of the natural environment on intensity footprints and event cascading is emphasized, one example being the generation of a “quake lake”. Future developments, à la SimCity, are finally discussed. Full article