<p>The generalizability of clinical trial outcomes hinges upon the equitable access and enrollment of diverse patient populations. Yet, disparities persist that may influence enrollment patterns. In neuroblastoma, the impact of ethnicity, socioeconomic status (SES), distance to care, and age at diagnosis on enrollment in therapeutic trials remains underexplored. We aimed to investigate these factors in neuroblastoma patients to identify potential disparities in clinical trial participation. We utilized the Childhood Cancer Research Network data, selecting neuroblastoma cases from 2008-2015, excluding those &amp;gt;21 years old or with incomplete data. We focused on factors influencing enrollment in therapeutic trials (ANBL0032, ANBL0421, ANBL0531, ANBL0532, ANBL0621, ANBL0931, ANBL1021, ANBL1221, ANBL1232). Key predictors examined were ethnicity, age at diagnosis, SES (via Yost Index), and distance to care from home to treatment hospital. We employed Poisson regression to calculate adjusted risk ratios (aRR) and 95% confidence intervals for trial participation. Analyzing 3,148 neuroblastoma cases from the CCRN registry, the ethnic composition was as follows: 68% were non-Hispanic White, 14% Hispanic, and 10% NH Black and SES distribution was even across quintiles. Age at diagnosis was a significant factor in trial enrollment: children &amp;gt;2 years were 94% more likely to enroll than those under 2 years (p &amp;lt; 0.001). Race, ethnicity, SES, and distance to care showed no significant effect on enrollment, all with non-significant p-values. In CCRN, neuroblastoma patient's age at diagnosis was a determinant in therapeutic trial enrollment, providing insight into design strategies to encourage trial participation. While common barriers like race, ethnicity, SES, and distance to care did not impact enrollment in our cohort, the significant role of age highlights an area where focused efforts can ensure that all age groups have equitable access to the potential benefits of therapeutic trials.</p>

Background: Learning health systems (LHSs) iteratively generate evidence that can

Background and Objectives: Long-term services and supports in the U.S. are increasingly

The number of sexual and gender minority (SGM) older adults utilizing residential long-term supports and services (LTSS) will increase in the forthcoming decades. Paradoxically, while requiring more LTSS services than their non-SGM counterparts, SGM older adults are less likely to access these services, partly due to fears of discrimination. Furthermore, SGM older adults living with Alzheimer’s disease and related dementias (AD/ADRD) present unique challenges and opportunities for LTSS facilities. This article provides a scoping review on the intersection between experiences of SGM older adults with AD/ADRD who use residential LTSS. This review identified three themes: (1) the experiences of discrimination among SGM residents in LTSS facilities, (2) the need for comprehensive staff training in residential LTSS to ensure proper care of SGM populations, and (3) the crucial role of inclusive facility policies. As the number of SGM older adults is expected to increase, further research is necessary.

Policymakers are interested in the long-term services and supports (LTSS) needs of people living with dementia. The National Core Indicators-Aging and Disability (NCI-AD) survey is conducted to eva...

<p>Introduction: Equitable participation in clinical trials for all populations is essential to ensure the generalizability of clinical trial results. Historical data suggest that the majority of pediatric patients are enrolled on a trial when treated at a cooperative group institution and minoritized patients are proportionally represented. We proposed to evaluate clinical trial enrollment on Children's Oncology Group (COG) acute lymphoblastic leukemia (ALL) studies to determine if among those who participate in registry studies, there are disparities in participation in therapeutic clinical trials. We hypothesized that minoritized children, those living in disadvantaged neighborhoods, and those living distant from trial sites are less likely to enroll on therapeutic ALL studies.</p>

Blood-feeding insects are important vectors for an array of zoonotic pathogens. While previous efforts toward generating molecular resources have largely focused on major vectors of global medical and veterinary importance, molecular data across a large number of hematophagous insect taxa remain limited. Advancements in long-read sequencing technologies and associated bioinformatic pipelines provide new opportunities for targeted sequencing of insect mitochondrial (mt) genomes. For engorged hematophagous insects, such technologies can be leveraged for both insect mitogenome genome assembly and identification of vertebrate blood-meal sources. We used nanopore adaptive sampling (NAS) to sequence genomic DNA from four species of field-collected, blood-engorged mosquitoes (Aedes and Culex spp.) and one deer fly (Chrysops sp.). NAS was used for bioinformatical enrichment of mtDNA reads of hematophagous insects and potential vertebrate blood-meal hosts using publically available mt genomes as references. We also performed an experimental control to compare results of traditional non-NAS nanopore sequencing to the mt genome enrichment by the NAS method. Complete mitogenomes were assembled and annotated for all five species sequenced with NAS: Aedes trivittatus, Aedes vexans, Culex restuans, Culex territans and the deer fly, Chrysops niger. In comparison to data generated during our non-NAS control experiment, NAS yielded a substantially higher proportion of reference-mapped mtDNA reads, greatly streamlining downstream mitogenome assembly and annotation. The NAS-assembled mitogenomes ranged in length from 15,582 to 16,045&nbsp;bp, contained between 78.1% and 79.0% A + T content and shared the anticipated arrangement of 13 protein-coding genes, two ribosomal RNAs, and 22 transfer RNAs. Maximum likelihood phylogenies were generated to further characterize each insect species. Additionally, vertebrate blood-meal analysis was successful in three samples sequenced, with mtDNA-based phylogenetic analyses revealing that blood-meal sources for Chrysops niger, Culex restuans and Aedes trivittatus were human, house sparrow (Passer domesticus) and eastern cottontail rabbit (Sylvilagus floridanus), respectively. Our findings show that NAS has dual utility to simultaneously molecularly identify hematophagous insects and their blood-meal hosts. Moreover, our data indicate NAS can facilitate a wide array of mitogenomic systematic studies through novel ‘phylogenetic capture’ methods. We conclude that the NAS approach has great potential for broadly improving genomic resources used to identify blood-feeding insects, answer phylogenetic questions and elucidate complex pathways for the transmission of vector-borne pathogens.

Interdisciplinary collaborations and team science are essential in advancing research across the aging continuum. This involves bringing together experts from different disciplines to work together to address complex topics related to aging. Yet, despite the value of building interdisciplinary collaborations, multiple barriers often exist, that include finding the time to connect, developing shared goals by faculty dispersed across different departments, and developing a commitment to learning from each other and having open communication. This symposium will review multi-pronged strategies to build interdisciplinary collaboration in aging as part of the Center for Healthy Aging and Innovation at the University of Minnesota. In particular, we will discuss the formation of Special Interest groups (SIGs), which have become one key way to encourage interdisciplinary collaborations. SIGs are member driven and are meant to encourage collaboration via joint publications, presentations and grant applications as well as other shared initiatives agreed upon by the group (e.g., resource identifications, book club). Each special group has its own sense of community and draws on members from different disciplines. The symposium will include presentations from four of the seven SIG chairs, focused on the Financial Decision Making SIG, Alzheimer’s Disease and Related Dementias SIG, Transportation SIG, and Aging and Chronic Disease Management SIG. Importantly, the symposium includes perspectives from faculty at different career ranks as well as PhD students.

Long-Term Services and Supports (LTSS) include medical, social, and personal care services that people may need to perform activities of daily living due to physical or cognitive impairments. Measuring the quality of LTSS is essential for improving the care and outcomes of people with disabilities and older adults and ensuring that services meet consumer needs. Several frameworks have been developed to measure LTSS quality, including the National Quality Forum’s LTSS Framework. Yet, few data sources are available to measure person-reported quality in HCBS. This symposium will provide an overview of National Core Indicators (NCI) as a unique data source to address this gap. It also includes presentations from researchers from organizations in two states who utilize NCI data – Minnesota and Massachusetts – who will share their perspectives about the value of the data, results from empirical analyses, and how they use and plan to use the data to inform policy. Researchers from the Lurie Institute for Disability Policy will present findings on the association between person-centered planning and key person-reported outcomes in Medicaid HCBS. Researchers from the University of Minnesota School of Public Health and Brown University will share findings from national NCI data on unmet needs among older adults by dementia status and race/ethnicity. They will also share results of analyses in MN, linking person-reported HCBS plan quality and healthcare utilization, using claims data. Collectively, this symposium will address the gap in measurement of HCBS quality nationally and identify key directions for policy and future research.

Assisted living (AL) describes long-term residential care settings that emphasize person-centered services and choice in a “home-like” environment. There is considerable variability in how AL is defined, what services are provided, and how quality is measured. Minnesota serves as a unique policy environment in which to study AL. In May 2019, Minnesota funded the development of an AL Report Card to measure and report on the quality of AL from resident and family perspectives, created in partnership with the University of Minnesota. Literature review, stakeholder feedback, and pilot testing were completed in 2020-21 and the survey was implemented statewide in 2021-22. Using 2021 AL resident quality of life (QoL) survey pilot data (N=1,392), the goal of this work was to assess the reliability and psychometric properties of the survey in measuring 7 QoL domains: food, staffing, environment, engagement, autonomy, culture, and security. The 7 domains were measured using 6, 10, 3, 6, 5, 3, and 6 items, respectively. We found acceptable internal consistency for four QoL domains: food, staff, security, and engagement (McDonald’s omega and Cronbach’s alpha ≥0.6). Confirmatory factor analysis was performed for each individual factor using diagonally weighted least squares for ordinal data. We found high interfactor correlations between the three domains with poor internal consistency (environment, culture, and autonomy). We collapsed these three domains into one overarching domain – climate – and found satisfactory data-model fit. Findings of stability and validity of QoL report card domains have important implications for adoption outside of Minnesota.

Sexual and gender minority (SGM) older adults face discrimination in long-term services and supports (LTSS). Yet, SGM older adults use LTSS disproportionately higher relative to their non-SGM count...

Objectives: To evaluate the evidence on effects of nurse staffing in nursing homes on resident outcomes. Design: Systematic review. Setting and Participants: Studies evaluating the effects of nurse staffing levels, total staffing, or skill mix on pressure ulcers, nursing home associated infections, and pain outcomes for adult residents in US nursing homes. Methods: We searched MEDLINE, Embase, CINAHL, and the Cochrane Database for English-language articles published between January 2000 and May 2021. We also searched for gray literature and sought expert referrals. Two reviewers participated in determination of eligibility, assessment of methodological quality, and abstraction of data. Abstracted data included study design; setting and population characteristics; and resident outcomes. We rated overall certainty of evidence (very low, low, moderate, and high) for each outcome using GRADE. Results: Of 9152 unique citations, 378 articles underwent full-text review. We identified 22 eligible studies that addressed pressure ulcers (k = 15), COVID-19 cases and/or mortality (k = 4), other infections (k = 8), and moderate-severe pain among residents (k = 7); some examined multiple outcomes. Most studies (k = 17) were rated moderate or high quality. All studies were observational. Overall, registered nurse (RN) staffing was probably associated with fewer pressure ulcers (moderate certainty) and possibly fewer COVID-19 infections/mortality (low certainty), other infections (low certainty) and lower rates of moderate-severe pain (low certainty). Higher skill mix was probably associated with fewer pressure ulcers, higher resident COVID-19 infections, fewer other infections, and lower rates of moderate-severe pain (low certainty for all outcomes). Conclusions and Implications: Higher RN staffing and skill mix may be associated with better nursing home resident outcomes, while results were mixed for total staffing. Increasing RN staffing levels and skill mix are one of a variety of approaches to improve nursing home care.

INTRODUCTION Acculturation and enculturation have been conceptualized, respectively, as risk and protective factors for cigarette use. Although acculturation/enculturation orientations are often studied as stable characteristics, they represent a dynamic process influenced by individuals' social environments and can fluctuate across time. Therefore, investigating how youth actively navigate their acculturation and enculturation beliefs and behaviors on a day-to-day basis can advance scientific understanding of factors related to cigarette use. Executive functions, including inhibitory control, shifting, and working memory, are robust predictors of smoking (e.g., cigarette use). However, we know little about the protective role of executive functions on the daily level associations between acculturation/enculturation and cigarette use among Mexican-origin youth. OBJECTIVES In a low-income Mexican-origin youth sample (M = 16.94, SD = 1.01; 52 % female), this study examined within-person associations between daily acculturation/enculturation and daily cigarette use and the moderating role of individual-level executive functions. METHOD We captured the daily fluctuations of acculturation/enculturation and smoking by utilizing data from a 4-day daily diary. The study assessed inhibitory control, shifting, and working memory using behavioral paradigms. RESULTS A multilevel logistic moderation model revealed statistically significant interactions between acculturation (but not enculturation) and all executive function skills predicting cigarette use. Higher daily acculturation levels were related to greater odds of daily cigarette use only for youth with lower levels of executive function skills. CONCLUSION Findings suggest that interventions aimed at improving executive functions may protect Mexican-origin youth from the possible adverse effect of acculturation on cigarette use.

Objectives: We investigated the relationship between the cognitive status of participants’ spouses and participants’ own cognitive outcomes, controlling for mid-life factors. Methods: Participants (n = 1845; baseline age 66–90 years) from the prospective Atherosclerosis Risk in Communities Study were followed from 2011 to 2019. We used linear regression and Cox proportional hazard models to estimate whether spouses of people with MCI/dementia had lower cognitive functioning and elevated risk of incident dementia. Results: Having a spouse with MCI/dementia was associated with a deficit in cognitive function (b = −0.09 standard deviations; 95% CI = −0.18, 0.00). Adjustment for mid-life risk factors attenuated this association (b = −0.02 standard deviations; 95% CI = −0.10, 0.06). We observed no significant relationship between spousal MCI/dementia status and incident dementia (hazard ratio = 0.97; 95% CI = 0.69, 1.38). Discussion: Spousal cognitive status is not associated with poor cognitive outcomes independent of mid-life factors.

Background and Objectives: Uncovering subgroups of nursing home (NH) residents sharing similar