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A stepped wedge cluster randomized trial to evaluate the effectiveness of a multisite family caregiver skills training program
(Wiley, 2024) Van Houtven, Courtney Harold; Coffman, Cynthia J.; Decosimo, Kasey; Grubber, Janet M.; Dadolf, Joshua; Sullivan, Caitlin; Tucker, Matthew; Bruening, Rebecca; Sperber, Nina R.; Stechuchak, Karen M.; Shepherd-Banigan, Megan; Boucher, Nathan; Ma, Jessica E.; Kaufman, Brystana G.; Colón-Emeric, Cathleen S.; Jackson, George L.; Damush, Teresa M.; Christensen, Leah; Wang, Virginia; Allen, Kelli D.; Hastings, Susan N.; Medicine, School of Medicine
Objective: To assess the effects of an evidence-based family caregiver training program (implementation of Helping Invested Families Improve Veteran Experiences Study [iHI-FIVES]) in the Veterans Affairs healthcare system on Veteran days not at home and family caregiver well-being.
Data sources and study setting: Participants included Veterans referred to home- and community-based services with an identified caregiver across 8 medical centers and confirmed family caregivers of eligible Veterans.
Study design: In a stepped wedge cluster randomized trial, sites were randomized to a 6-month time interval for starting iHI-FIVES and received standardized implementation support. The primary outcome, number of Veteran "days not at home," and secondary outcomes, changes over 3 months in measures of caregiver well-being, were compared between pre- and post-iHI-FIVES intervals using generalized linear models including covariates.
Data collection/extraction methods: Patient data were extracted from the electronic health record. Caregiver data were collected from 2 telephone-based surveys.
Principal findings: Overall, n = 898 eligible Veterans were identified across pre-iHI-FIVES (n = 327) and post-iHI-FIVES intervals (n = 571). Just under one fifth (17%) of Veterans in post-iHI-FIVES intervals had a caregiver enroll in iHI-FIVES. Veteran and caregiver demographics in pre-iHI-FIVES intervals were similar to those in post-iHI-FIVES intervals. In adjusted models, the estimated rate of days not at home over 6-months was 42% lower (rate ratio = 0.58 [95% confidence interval: 0.31-1.09; p = 0.09]) post-iHI-FIVES compared with pre-iHI-FIVES. The estimated mean days not at home over a 6-month period was 13.0 days pre-iHI-FIVES and 7.5 post-iHI-FIVES. There were no differences between pre- and post-iHI-FIVES in change over 3 months in caregiver well-being measures.
Conclusions: Reducing days not at home is consistent with effectiveness because more time at home increases quality of life. In this study, after adjusting for Veteran characteristics, we did not find evidence that implementation of a caregiver training program yielded a reduction in Veteran's days not at home.
Macrophage peroxisomes guide alveolar regeneration and limit SARS-CoV-2 tissue sequelae
(American Association for the Advancement of Science, 2025) Wei, Xiaoqin; Qian, Wei; Narasimhan, Harish; Chan, Ting; Liu, Xue; Arish, Mohd; Young, Samuel; Li, Chaofan; Cheon, In Su; Yu, Qing; Almeida-Santos, Gislane; Zhao, Xiao-Yu; Yeatts, Eric V.; Spear, Olivia J.; Yi, Megan; Parimon, Tanyalak; Fang, Yinshan; Hahn, Young S.; Bullock, Timothy N. J.; Somerville, Lindsay A.; Kaplan, Mark H.; Sperling, Anne I.; Shim, Yun Michael; Vassallo, Robert; Chen, Peter; Ewald, Sarah E.; Roden, Anja C.; Que, Jianwen; Jiang, Dianhua; Sun, Jie; Microbiology and Immunology, School of Medicine
Peroxisomes are vital but often overlooked metabolic organelles. We found that excessive interferon signaling remodeled macrophage peroxisomes. This loss of peroxisomes impaired inflammation resolution and lung repair during severe respiratory viral infections. Peroxisomes were found to modulate lipid metabolism and mitochondrial health in a macrophage type-specific manner and enhanced alveolar macrophage-mediated tissue repair and alveolar regeneration after viral infection. Peroxisomes also prevented excessive macrophage inflammasome activation and IL-1β release, limiting accumulation of KRT8high dysplastic epithelial progenitors following viral injury. Pharmacologically enhancing peroxisome biogenesis mitigated both acute symptoms and post-acute sequelae of COVID-19 (PASC) in animal models. Thus, macrophage peroxisome dysfunction contributes to chronic lung pathology and fibrosis after severe acute respiratory syndrome coronavirus 2 infection.
Interprofessional Teaching Model for Enhancing Musculoskeletal Examination: Does the Learning Event Length Matter?
(2026-02-13) Donovan, Cameron; Wilcox, James; Lobo, Daniela; Bayliss, Amy
Racial disparities in hydrocephalus mortality and shunt revision: a study from the Hydrocephalus Clinical Research Network
(American Association of Neurological Surgeons, 2025-03-21) Rocque, Brandon G.; Jensen, Hailey; Reeder, Ron W.; Rozzelle, Curtis J.; Kulkarni, Abhaya V.; Pollack, Ian F.; McDowell, Michael; Naftel, Robert P.; Jackson, Eric M.; Whitehead, William E.; Pindrik, Jonathan A.; Isaacs, Albert; Strahle, Jennifer M.; McDonald, Patrick J.; Tamber, Mandeep S.; Hankinson, Todd C.; Browd, Samuel R.; Hauptman, Jason S.; Krieger, Mark D.; Chu, Jason; Riva-Cambrin, Jay; Limbrick, David D., Jr.; Holubkov, Richard; Kestle, John R. W.; Wellons, John C., III; Hydrocephalus Clinical Research Network; Neurological Surgery, School of Medicine
Objective: Several studies of administrative data have noted higher mortality rates for Black/African American children with shunted hydrocephalus. A longitudinal study of children with hydrocephalus secondary to myelomeningocele showed lower lifetime rates of shunt revision in minority children compared to White children, indicating a possible disparity in hydrocephalus treatment. The goal of this study is to identify racial and ethnic disparities in mortality or in shunt revision rates by using the Hydrocephalus Clinical Research Network (HCRN) hydrocephalus registry sample.
Methods: The HCRN registry was queried for patients with shunted hydrocephalus for whom data on all lifetime hydrocephalus procedures were available. Patients with a primary shunt placement prior to 2023 were included, with follow-up extending through March 19, 2024. A Cox proportional hazards model was created to determine the effect of race and ethnicity on mortality while controlling for age at initial shunt placement, sex, hydrocephalus etiology, gestational age at birth, and presence of complex chronic conditions. Similarly, a proportional means model was used to evaluate association with lifetime number of shunt revision surgeries. The authors' hypothesis was that when controlling for other variables, minority children would have higher mortality and fewer shunt revision surgeries than White children.
Results: A total of 5656 children were included in the analysis of mortality. There were 579 deaths. Race and ethnicity were independently associated with mortality, with Black (HR 1.32, 95% CI 1.05-1.65), other non-White (HR 1.39, 95% CI 1.03-1.86), and Hispanic (HR 1.50, 95% CI 1.22-1.84) children having a higher mortality rate than White children. In the analysis of 4081 children with shunts, Hispanic ethnicity was also independently associated with fewer total shunt revisions (HR 0.84, 95% CI 0.72-0.98).
Conclusions: In children with hydrocephalus, when controlling for other factors, there is a higher mortality rate among Hispanic, Black, and other non-White children, and fewer shunt revisions among Hispanic children. These findings highlight important potential disparities in hydrocephalus treatment.
Cognitive impairment among older adults' pilgrims during Hajj: a cross-sectional study of prevalence and associated factors
(BioMed Central, 2025-12-01) Alkhotani, Amar Mohammad A.; Obaid, Majed S.; Hariri, Nahla H.; Alqashqri, Hamsah Saleh; Alghamdi, Ismail A.; Siddiqui, Muhammad Irfanullah; Adly, Heba M.; Garout, Mohammed A.; Bulkhi, Adeeb A.; Almoallim, Hani M.; Elfaki, Elbagir A.; Alhazmi, Aous S.; Al-Tawfiq, Jaffar A.; Bagabir, Rania Abubaker; Saleh, Saleh A. K.; Bawahab, Nizar S.; Kazim, Albaraa H.; Alamri, Fahad A.; Khan, Anas A.; Medicine, School of Medicine
Background: Hajj, one of the largest annual religious gatherings, attracts millions of Muslim pilgrims globally, with a significant proportion being older adults. Cognitive impairment, encompassing mild cognitive decline to dementia, is a prevalent condition among older adults and can significantly affect their ability to participate in the physically and mentally demanding rituals of Hajj. Despite its implications, data on the prevalence and associated factors of cognitive impairment among pilgrims remain limited.
Objective: This study aimed to assess the prevalence of cognitive impairment among older adults Hajj pilgrims and to explore its associations with demographic, linguistic, and medical history variables.
Methods: A cross-sectional study was conducted during the 1445 Hijri Calander (2024 AD) Hajj season in Makkah, Saudi Arabia. A total of 3,111 pilgrims aged 60 years and older were recruited using multistage sampling. Data were collected through bilingual (Arabic and English) face-to-face interviews, employing the validated Ascertain Dementia 8 (AD8) screening tool. Additional data included demographic characteristics, health conditions, medication use, and cognitive challenges. Statistical analyses included Chi-square tests, logistic regression, and descriptive summaries to determine significant predictors of cognitive impairment.
Results: The prevalence of positive cognitive screening impairment was 64.0%, with a mean AD8 score of 3.09 ± 2.68. Participants aged 80 years and above exhibited the highest prevalence (78.5%), followed by those aged 70-79 years (67.2%) and 60-69 years (58.4%) (p < 0.001). Urdu-speaking individuals (OR: 2.132, 95% CI: 1.018-4.468), Nigerian nationality (OR: 7.594, 95% CI: 1.951-29.555), and Southeast Asia clusters (p = 0.033, OR: 2.086, 95% CI: 1.059-4.108) had a significantly higher prevalence of cognitive impairment by screening. Chronic conditions such as diabetes (OR: 1.839, p < 0.001), hypertension (OR: 2.420, p < 0.001), and hyperlipidemia (OR: 1.446, p = 0.001) were significantly associated with cognitive impairment positive screening along with prior cognitive impairment disorders diagnosis (OR: 2.367, p = 0.038). Participants who reported difficulties with remembering appointments (40.3%) and managing finances (34.6%) were more likely to exhibit cognitive impairment positive screening.
Conclusion: Probable cognitive impairment positive screening among older adults Hajj pilgrims was significantly associated with clinical factors including diabetes, hypertension, hyperlipidemia, prior diagnosis of cognitive impairment disorders, and informant-based reporting. These findings underscore the importance of pre-travel cognitive assessments, targeted health interventions, and culturally sensitive support services to ensure safe and inclusive participation. This study provides crucial evidence to guide future healthcare policies and interventions aimed at supporting older adults' pilgrims.