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Item Adapting to CONNECT: modifying a nursing home-based team-building intervention to improve hospital care team interactions, functioning, and implementation readiness(BMC, 2022-07-29) Wang, Virginia; D’Adolf, Joshua; Decosimo, Kasey; Robinson, Katina; Choate, Ashley; Bruening, Rebecca; Sperber, Nina; Mahanna, Elizabeth; Van Houtven, Courtney H.; Allen, Kelli D.; Colón-Emeric, Cathleen; Damush, Teresa M.; Hastings, Susan N.; Medicine, School of MedicineBackground: Clinical interventions often need to be adapted from their original design when they are applied to new settings. There is a growing literature describing frameworks and approaches to deploying and documenting adaptations of evidence-based practices in healthcare. Still, intervention modifications are often limited in detail and justification, which may prevent rigorous evaluation of interventions and intervention adaptation effectiveness in new contexts. We describe our approach in a case study, combining two complementary intervention adaptation frameworks to modify CONNECT for Quality, a provider-facing team building and communication intervention designed to facilitate implementation of a new clinical program. Methods: This process of intervention adaptation involved the use of the Planned Adaptation Framework and the Framework for Reporting Adaptations and Modifications, for systematically identifying key drivers, core and non-core components of interventions for documenting planned and unplanned changes to intervention design. Results: The CONNECT intervention's original context and setting is first described and then compared with its new application. This lays the groundwork for the intentional modifications to intervention design, which are developed before intervention delivery to participating providers. The unpredictable nature of implementation in real-world practice required unplanned adaptations, which were also considered and documented. Attendance and participation rates were examined and qualitative assessment of reported participant experience supported the feasibility and acceptability of adaptations of the original CONNECT intervention in a new clinical context. Conclusion: This approach may serve as a useful guide for intervention implementation efforts applied in diverse clinical contexts and subsequent evaluations of intervention effectiveness.Item Architecture for Mobile Heterogeneous Multi Domain Networks(Hindawi, 2010-04-01) Durresi, Arjan; Zhang, Ping; Durresi, Mimoza; Barolli, Leonard; Computer and Information Science, School of ScienceMulti domain networks can be used in several scenarios including military, enterprize networks, emergency networks and many other cases. In such networks, each domain might be under its own administration. Therefore, the cooperation among domains is conditioned by individual domain policies regarding sharing information, such as network topology, connectivity, mobility, security, various service availability and so on. We propose a new architecture for Heterogeneous Multi Domain (HMD) networks, in which one the operations are subject to specific domain policies. We propose a hierarchical architecture, with an infrastructure of gateways at highest-control level that enables policy based interconnection, mobility and other services among domains. Gateways are responsible for translation among different communication protocols, including routing, signalling, and security. Besides the architecture, we discuss in more details the mobility and adaptive capacity of services in HMD. We discuss the HMD scalability and other advantages compared to existing architectural and mobility solutions. Furthermore, we analyze the dynamic availability at the control level of the hierarchy.Item Correlates of Gait Speed Among Older Adults From 6 Countries: Findings From the COSMIC Collaboration(Oxford University Press, 2023) Sprague, Briana N.; Zhu, Xiaonan; Rosso, Andrea L.; Verghese, Joe; Delbaere, Kim; Lipnicki, Darren M.; Sachdev, Perminder S.; Ng, Tze Pin; Gwee, Xinyi; Yap, Keng Bee; Kim, Ki-Woong; Han, Ji Won; Oh, Dae Jong; Narazaki, Kenji; Chen, Tao; Chen, Sanmei; Brodaty, Henry; Numbers, Katya; Kochan, Nicole A.; Walker, Richard W.; Paddick, Stella-Maria; Gureje, Oye; Ojagbemi, Akin; Bello, Toyin; Rosano, Caterina; COSMIC Consortium; Medicine, School of MedicineBackground: Few studies have compared gait speed and its correlates among different ethnogeographic regions. The goals of this study were to describe usual and rapid gait speed, and identify their correlates across Australian, Asian, and African countries. Methods: We used data from 6 population-based cohorts of adults aged 65+ from 6 countries and 3 continents (N = 6 472), with samples ranging from 231 to 1 913. All cohorts are members of the Cohort Studies of Memory in an International Consortium collaboration. We investigated whether clinical (body mass index [BMI], hypertension, stroke, apolipoprotein status), psychological (cognition, mood, general health), and behavioral factors (smoking, drinking, physical activity) correlated with usual (N = 4 cohorts) and rapid gait speed (N = 3 cohorts) similarly across cohorts. Regression models were controlled for age, sex, and education, and were sex-stratified. Results: Age- and sex-standardized usual gait speed means ranged from 0.61 to 1.06 m/s and rapid gait speed means ranged from 1.16 to 1.64 m/s. Lower BMI and better cognitive function consistently correlated with faster gait speed in all cohorts. Less consistently, not having hypertension and greater physical activity engagement were associated with faster gait speed. Associations with mood, smoking, and drinking were largely nonsignificant. These patterns were not attenuated by demographics. There was limited evidence that the associations differed by sex, except physical activity, where the greater intensity was associated with usual gait among men but not women. Conclusions: This study is among the first to describe the usual and rapid gait speeds across older adults in Africa, Asia, and Australia.Item Hospital-associated functional status decline in pulmonary patients(2017-06-26) Shay, Amy Cornett; Fulton, Janet; Von Ah, Diane; Otte, Julie Elam; Warden, Stuart J.; O'Malley, PatriciaChronic obstructive pulmonary disease (COPD) is a significant worldwide cause of chronic illness and mortality and one of the most common admitting diagnoses in the United States. Persons with COPD are at increased risk for deconditioning during hospitalization, which can lead to decreased functional status at discharge. Disease-related factors and elements of the hospital environment make older adults with COPD vulnerable to hospital-associated functional status decline. The purpose of this dissertation was to identify activity factors that contribute to hospital-associated functional status decline in older adults with COPD by promoting functioning during hospitalization. This predictive correlational study is a secondary analysis of a pre-existing dataset. Patients with COPD were pulled from the larger parent study sample for comparison with patients without COPD. The convenience sample consisted of 111 patients with COPD and 190 patients without COPD. Subjects were 46.5% male, 53.5% female, and a mean age of 66 years. All subjects were patients admitted to a pulmonary unit and received an intervention protocol designed to address mobility barriers related to COPD and hospitalization. Statistical analysis explored the number, type, and timing of activity events in relation to the selected functional status outcomes of discharge disposition, length of hospital stay, and 30-day readmission rates for hospitalized older adults with COPD. Multivariate and bivariate analyses results indicated ambulation to the bathroom, ambulation outside the patient room, and number of days to first out-of-bed activity were significant predictors (p < 0.05) of patient discharge to home; days to first activity and ambulation were significant predictors (p < 0.05) of reduced length of stay; none of the variables were predictive of 30-day readmission. Patients with COPD experienced longer lengths of stay and more non-weight bearing activity than patients without COPD in this sample. These findings provide a foundation for future research to explore hospital environmental factors influencing mobility, determine optimal modes of activity during hospitalization, and examine potential cost savings associated with promotion of early mobility. Findings help explain the effects of physical activity during hospitalization and may aid development of nursing interventions to prevent or alleviate functional status decline in this vulnerable population.Item Impacts of state COVID-19 reopening policy on human mobility and mixing behavior(Wiley, 2021) Nguyen, Thuy D.; Gupta, Sumedha; Andersen, Martin S.; Bento, Ana I.; Simon, Kosali I.; Wing, Coady; Economics, School of Liberal ArtsThis study quantifies the effect of the 2020 state COVID economic activity reopening policies on daily mobility and mixing behavior, adding to the economic literature on individual responses to public health policy that addresses public contagion risks. We harness cellular device signal data and the timing of reopening plans to provide an assessment of the extent to which human mobility and physical proximity in the United States respond to the reversal of state closure policies. We observe substantial increases in mixing activities, 13.56% at 4 days and 48.65% at 4 weeks, following reopening events. Echoing a theme from the literature on the 2020 closures, mobility outside the home increased on average prior to these state actions. Furthermore, the largest increases in mobility occurred in states that were early adopters of closure measures and hard-hit by the pandemic, suggesting that psychological fatigue is an important barrier to implementation of closure policies extending for prolonged periods of time.Item Impacts of State Reopening Policy on Human Mobility(National Bureau of Economic Research, 2020-05) Nguyen, Thuy D.; Gupta, Sumedha; Andersen, Martin; Bento, Ana; Simon, Kosali I.; Wing, Coady; O’Neill School of Public and Environmental Affairs, IU & IUPUIThis study quantifies the effect of state reopening policies on daily mobility, travel, and mixing behavior during the COVID-19 pandemic. We harness cell device signal data to examine the effects of the timing and pace of reopening plans in different states. We quantify the increase in mobility patterns during the reopening phase by a broad range of cell-device-based metrics. Soon (four days) after reopening, we observe a 6% to 8% mobility increase. In addition, we find that temperature and precipitation are strongly associated with increased mobility across counties. The mobility measures that reflect visits to a greater variety of locations responds the most to reopening policies, while total time in vs. outside the house remains unchanged. The largest increases in mobility occur in states that were late adopters of closure measures, suggesting that closure policies may have represented more of a binding constraint in those states. Together, these four observations provide an assessment of the extent to which people in the U.S. are resuming movement and physical proximity as the COVID-19 pandemic continues.Item Life-course and population health perspectives to fill gaps in migrant health research(FrancoAngeli, 2020) Ahonen, Emily Q.; Fujishiro, Kaori; Environmental Health Science, School of Public HealthThis article highlights categories and dichotomies used in the study of the health of migrants, including migrant motivation, migrant type, pre- and post-migration time periods, and health as biomedically or socially determined. The authors suggest that the full spectrum of migrants and migration be considered more thoroughly in order to improve our understanding of migrant health. This paper challenges simple conceptions of migration, mobility, and migrant experience. To fill gaps in knowledge left by these conceptions, researchers must recognize the decisions migrants make as a process which plays out both over time (in migrant life-courses) and also across personal, national, and international contexts which connect the individual to larger structures and phenomena. The authors argue that, in this reality, research questions related to migrant health are best addressed using life-course perspectives which recognize health as a continuum of socially-constructed statuses.Item Relative leg press strength relates to activity energy expenditure in older women: Implications for exercise prescription(Elsevier, 2022-11) Carter, Stephen J.; Singh, Harshvardan; Nabhan, Dustin C.; Long, Emily B.; Hunter, Gary R.; Melvin and Bren Simon Comprehensive Cancer CenterLimited work has evaluated how leg press strength (LPS), relative to body mass (i.e., rLPS), affects heart rate (HR) responses during activities of daily living. Such information would prove useful by informing a specific level of rLPS needed to promote independent mobility and physical activity. Secondary analyses were performed on baseline measures of 76 untrained older (65 ± 4 y) women. After familiarization, one-repetition maximum leg press was converted to rLPS by dividing the external load lifted (kg) by body mass (BM). Participants were stratified according to percentile of age-group norms of rLPS: ≤50 % (low, ≤0.99 kg/BM, n = 15), 51–89 % (middle, 1.0–1.31 kg/BM, n = 31), and ≥90 % (high, ≥1.32 kg/BM, n = 30). HR was measured at rest and during laboratory-based tasks including fixed-speed (0.89 m·s−1) non-graded treadmill walking, graded (2.5 %) treadmill walking, and stair stepping. Maximal oxygen uptake (V̇O2max) was measured via indirect calorimetry. Doubly labeled water was used to quantify activity energy expenditure (AEE) over a 14-d period. Relative LPS per group were: 0.85 ± 0.12 (low), 1.16 ± 0.09 (middle), and 1.55 ± 0.25 (high) (p < 0.001). Significant between-group differences in HR emerged during both walking tasks and stair stepping – with the high rLPS group having the lowest HR. AEE between-group comparisons did not yield statistical significance (p = 0.084), however, rLPS correlated with AEE (r = 0.234, p = 0.042) and V̇O2max (r = 0.430, p < 0.001). Such findings suggest a higher rLPS attenuates HR for weight-bearing activities while also demonstrating a significant, albeit modest, positive link to AEE among older women. This information may be especially relevant for informing thresholds of rLPS linked to mobility and functional independence in older women.Item SOCIAL COHESION, TRANSPORTATION, AND PARTICIPATION IN SOCIAL ACTIVITIES AMONG OLDER ADULTS(Oxford University Press, 2019-11) Latham-Mintus, Kenzie; Miller, Keith; School of Social WorkObjectives: The purpose of this research is to examine the role that social cohesion and access (conceptualized as mobility and transportation) plays on participation in social activities (i.e., visiting friends/family, attending religious services, participating in organizations, and going out for enjoyment). Participation in valued, social activities promotes of well-being through social interactions and the maintenance of personally meaningful relationships and lifestyles. Methods: Data from the National Health and Aging Trends (NHATS) study were used. The NHATS is representative of U.S. Medicare recipients ages 65 and older. The NHATS collects information on health and participation as well as detailed environmental measures, which makes it well suited for this research. Results: Higher ratings of social cohesion were associated with higher cumulative odds of participating in social activities among older adults, net of sociodemographic characteristics, personal network size, neighborhood disorder, and health factors. Taking public transportation services and walking places were associated with higher cumulative odds of participating in social activities. An interaction between social cohesion and walking places was significant (p=0.002). Older adults who reported high levels of social cohesion and walked to get around their community were more likely to participate in social activities compared with those reporting low social cohesion and walking as a transportation. Discussion: This research provides evidence that socially cohesive neighborhoods enable greater access to social activities through transportation services. Offering a range of transportation services is only piece of creating an age-friendly community—older adults must also feel comfortable using these options.Item Social isolation in chronic kidney disease and the role of mobility limitation(Oxford University Press, 2019-01-14) Moorthi, Ranjani N.; Latham-Mintus, Kenzie; Medicine, School of MedicineBackground: Chronic kidney disease (CKD) is associated with multiple comorbidities, hospitalizations and mortality. In older adults, social isolation and poor mobility contribute to these outcomes. We tested the hypothesis that a glomerular filtration rate (GFR) <45 mL/min/1.73 m2 (CKD Stages 3b-5) is associated with social isolation and that mobility limitation is a key driver of social isolation in patients with CKD. Methods: Data from 9119 participants, ages 57-107 years, from the 2016 wave of the Health and Retirement Study's Venous Blood Study were used for this cross-sectional analysis. Kidney function measured by estimated GFR (eGFR) was the predictor and patients were classified as CKD Stages 3b-5 or non-CKD Stages 3b-5 (eGFR ≤45 or >45 mL/min/1.73 m2). The outcomes tested were mobility limitation assessed by self-report and social contact and participation measures assessed by the Psychosocial Life Questionnaire. The associations among kidney function, mobility and social isolation were examined with logistic and ordinary least squares regression, adjusted for covariates and testing for interaction with gender. Results: Participants with CKD Stages 3b-5 (N = 999) compared with non-CKD Stages 3b-5 were older (74.9 versus 68.2 years, P < 0.001) and fewer were female (15% versus 58%, P < 0.001). CKD Stages 3b-5 were associated with higher odds of difficulty walking several blocks [odds ratio 1.44 (95% confidence interval 1.16-1.78)]. Participants with CKD Stages 3b-5 had reduced social contact and social participation (B = -0.23, P < 0.05; B = -0.62, P < 0.05, respectively). Women with CKD Stages 3b-5 were 2.7 times more likely to report difficulty walking several blocks than men with CKD Stages 3b-5, but social isolation in CKD Stages 3b-5 did not vary by gender. In CKD Stages 3b-5 patients, mobility limitation was a risk factor for reduced social contact and participation but did not explain the poor social contact and participation. Conclusion: CKD Stages 3b-5 was associated with both mobility limitation and social isolation in a population-based study of older adults. In contrast to older adults without CKD Stages 3b-5, mobility limitation did not explain the lack of social contact and poor social participation, suggesting other factors are more important.