IMPORTANCE Postoperative delirium in older adults is a common and costly complication after surgery. Cognitive reserve affects the risk of postoperative delirium, and thus preoperative augmentation of reserve as a preventive technique is of vital interest. OBJECTIVE To determine whether cognitive prehabilitation reduces the incidence of postoperative delirium among older adults. DESIGN, SETTING, AND PARTICIPANTS This was a prospective, single-blinded randomized clinical trial conducted from March 2015 to August 2019 at the Ohio State University Wexner Medical Center in Columbus. Patients 60 years and older undergoing major, noncardiac, nonneurological surgery under general anesthesia, with an expected hospital stay of at least 72 hours, were eligible for trial inclusion. Patients were excluded for preoperative cognitive dysfunction and active depression. INTERVENTIONS Participation in electronic, tablet-based preoperative cognitive exercise targeting memory, speed, attention, flexibility, and problem-solving functions. MAIN OUTCOMES AND MEASURESThe primary outcome was incidence of delirium between postoperative day 0 to day 7 or discharge, as measured by a brief Confusion Assessment Method, Memorial Delirium Assessment Scale, or a structured medical record review. Secondary outcomes compared delirium characteristics between patients in the intervention and control groups. RESULTSOf the 699 patients approached for trial participation, 322 completed consent and 268 were randomized. Subsequently, 17 patients were excluded, leaving 251 patients in the primary outcome analysis. A total of 125 patients in the intervention group and 126 control patients were included in the final analysis (median [interquartile range] age, 67 [63][64][65][66][67][68][69][70][71] years; 163 women [64.9%]). Ninety-seven percent of the patients in the intervention group completed some brain exercise (median, 4.6 [interquartile range, 1.31-7.4] hours). The delirium rate among control participants was 23.0% (29 of 126). With intention-to-treat analysis, the delirium rate in the intervention group was 14.4% (18 of 125; P = .08). Post hoc analysis removed 4 patients who did not attempt any cognitive exercise from the intervention group, yielding a delirium rate of 13.2% (16 of 121; P = .04). Secondary analyses among patients with delirium showed no differences in postoperative delirium onset day or duration or total delirium-positive days across study groups. CONCLUSIONS AND RELEVANCEThe intervention lowered delirium risk in patients who were at least minimally compliant. The ideal activities, timing, and effective dosage for cognitive exercise-based interventions to decrease postoperative delirium risk and burden need further study.

The present study examined the long-term cognitive implications of cancer treatment among breast cancer survivors aged 65 years and older. Fifty-seven women survivors were compared to 30 healthy older female adult comparisons, matched in terms of age and education, with no history of cancer. Cancer survivors were also compared based on treatment intervention, involving chemotherapy (n = 27) versus local therapy through surgery and radiation (n = 30). As a group, the breast cancer survivors scored lower on measures of general cognitive function, working memory, psychomotor speed, and executive function, when compared to the normal comparisons. Among the cancer survivors, those who received local therapy scored lower than the other survivors and normal comparisons on measures of verbal learning, visual perception and construction, as well as visual attention and short-term retention. Our findings suggest that cognitive outcomes may involve more age-related deficits among older cancer survivors compared to matched healthy subjects.

Objectives: Dolutegravir/lamivudine (DTG/3TC) is indicated for treatment-naive and experienced people with HIV; however, questions remain about its utility in a test-and-treat setting because of potential transmitted resistance and baseline hepatitis B virus (HBV) co-infection. We present feasibility and efficacy of DTG/3TC in newly diagnosed individuals in a test-and-treat setting. Design: The single-arm STAT study evaluated DTG/3TC in a US test-and-treat setting. Methods: Eligible adults initiated DTG/3TC 14 days or less after HIV-1 diagnosis without availability of baseline laboratory results. If baseline testing indicated DTG or 3TC resistance, HBV co-infection, or creatinine clearance less than 30 ml/min per 1.73 m 2 , participants remained on study with treatment modification. Efficacy endpoints included proportions of participants with HIV-1 RNA less than 50 copies/ml at Week 24, regardless of antiretroviral regimen, among all participants (intention-to-treat exposed) and those with available HIV-1 RNA data (observed). Results: Of 131 participants enrolled, 8% were female and 50% were non-white. Through Week 24, treatment was modified in eight participants [five with HBV co-infection, one with baseline M184V, one for adverse event (rash), one participant decision]. At Week 24, 78% (102/131) of all participants and 92% (102/111) of those with available data achieved HIV-1 RNA less than 50 copies/ml. Incidence of drug-related adverse events was low (7%); no drug-related serious adverse events occurred. Conclusion: These data demonstrate the feasibility, efficacy, and safety of using DTG/3TC as a first-line regimen in a test-and-treat setting, with therapy adjustments for baseline resistance or HBV co-infection occurring safely via routine clinical care as needed [ClinicalTrials.gov, NCT03945981; see Supplemental Digital Content 1, video abstract (Video abstract summarizing the STAT study design and results)].

Body core cooling via the palm of a hand increases work volume during resistive exercise. We asked: (a) "Is there a correlation between elevated core temperatures and fatigue onset during resistive exercise?" and (b) "Does palm cooling between sets of resistive exercise affect strength and work volume training responses?" Core temperature was manipulated by 30-45 minutes of fixed load and duration treadmill exercise in the heat with or without palm cooling. Work volume was then assessed by 4 sets of fixed load bench press exercises. Core temperatures were reduced and work volumes increased after palm cooling (Control: Tes = 39.0 ± 0.1° C, 36 ± 7 reps vs. Cooling: Tes = 38.4 ± 0.2° C, 42 ± 7 reps, mean ± SD, n = 8, p < 0.001). In separate experiments, the impact of palm cooling on work volume and strength training responses were assessed. The participants completed biweekly bench press or pull-up exercises for multiple successive weeks. Palm cooling was applied for 3 minutes between sets of exercise. Over 3 weeks of bench press training, palm cooling increased work volume by 40% (vs. 13% with no treatment; n = 8, p < 0.05). Over 6 weeks of pull-up training, palm cooling increased work volume by 144% in pull-up experienced subjects (vs. 5% over 2 weeks with no treatment; n = 7, p < 0.001) and by 80% in pull-up naïve subjects (vs. 20% with no treatment; n = 11, p < 0.01). Strength (1 repetition maximum) increased 22% over 10 weeks of pyramid bench press training (4 weeks with no treatment followed by 6 weeks with palm cooling; n = 10, p < 0.001). These results verify previous observations about the effects of palm cooling on work volume, demonstrate a link between core temperature and fatigue onset during resistive exercise, and suggest a novel means for improving strength and work volume training responses.

Photochemical reduction of aqueous Ag+ and [AuCl4]− into alloy Au–Ag nanoparticles (Au–Ag NPs) with intense laser pulses is a green synthesis approach that requires no toxic chemical reducing agents or stabilizers; however size control without capping agents still remains a challenge. Hydrated electrons produced in the laser plasma can reduce both [AuCl4]− and Ag+ to form NPs, but hydroxyl radicals (OH·) in the plasma inhibit Ag NP formation by promoting the back-oxidation of Ag0 into Ag+. In this work, femtosecond laser reduction is used to synthesize Au–Ag NPs with controlled compositions by adding the OH· scavenger isopropyl alcohol (IPA) to precursor solutions containing KAuCl4 and AgClO4. With sufficient IPA concentration, varying the precursor ratio enabled control over the Au–Ag NP composition and produced alloy NPs with average sizes less than 10 nm and homogeneous molar compositions of Au and Ag. By investigating the kinetics of Ag+ and [AuCl4]− coreduction, we find that the reduction of [AuCl4]− into Au–Ag NPs occurs before most of the Ag+ is incorporated, giving us insight into the mechanism of Au–Ag NP formation.

Objectives Hypertension increases the risk of developing Alzheimer's disease or related dementias. This pilot study's purpose was to examine the feasibility and acceptability of a novel intervention, Mindfulness in Motion (MIM) and Dietary Approaches to Stop Hypertension DASH (MIM DASH), to improve diet, mindfulness, stress, and systolic blood pressure (BP) in older African Americans with mild cognitive impairment (MCI) and hypertension. Design Cluster randomized controlled trial. Setting Intergenerational community center in a large metropolitan area. Participants African Americans with MCI and hypertension. Participants were divided into six groups randomized 1:1:1 to the MIM DASH group, attention only (non‐hypertensive education) group, or true control group. The MIM DASH and attention only interventions were delivered in 8‐weekly 2 hour group sessions. MIM included mindful movements from chair/standing, breathing exercises, and guided meditation. The DASH component used a critical thinking approach of problem solving, goal setting, reflection, and self‐efficacy. The true control group received a DASH pamphlet at the end. Measurements Feasibility was tracked through enrollment and attendance records; acceptability was assessed through interviews. Blood pressure was measured using the Omron HEM‐907XL Monitor. Dietary intake was measured by DASH‐Q. Mindfulness was measured by the Cognitive and Affective Mindfulness Scale. Stress was measured by the Perceived Stress Scale. MCI was determined using the Self‐Administered Gerocognitive Examination. Data were collected at baseline and 3‐months. Results Median session attendance was six for the MIM DASH group and six for the attention only group. There were no changes in diet, mindfulness, or stress. There was a clinically significant reduction in systolic BP in the MIM DASH group (−7.2 mmHg) relative to the attention only group (−.7), and no change between the MIM DASH and true control groups. Conclusion Results indicate that the MIM DASH intervention was feasible and culturally acceptable in African Americans with hypertension and MCI.

The capacity to make sound financial decisions across the lifespan is critical for interpersonal, occupational, and psychological health and success. In the present study, we explored how healthy younger and older adults make a series of increasingly complex financial decisions. One-hundred sixteen healthy older adults, aged 56–90 years, and 102 college undergraduates, completed the Financial Decision-Making Questionnaire, which requires selecting and justifying financial choices across four hypothetical scenarios and answering questions pertaining to financial knowledge. Results indicated that Older participants significantly outperformed Younger participants on a multiple-choice test of acquired financial knowledge. However, after controlling for such pre-existing knowledge, several age effects were observed. For example, Older participants were more likely to make immediate investment decisions, whereas Younger participants exhibited a preference for delaying decision-making pending additional information. Older participants also rated themselves as more concerned with avoiding monetary loss (i.e., a prevention orientation), whereas Younger participants reported greater interest in financial gain (i.e., a promotion orientation). In terms of sex differences, Older Males were more likely to pay credit card bills and utilize savings accounts than were Older Females. Multiple positive correlations were observed between Older participants’ financial decision-making ability and performance on neuropsychological measures of non-verbal intellect and executive functioning. Lastly, the ability to justify one’s financial decisions declined with age, among the Older participants. Several of the aforementioned results parallel findings from the medical decision-making literature, suggesting that older adults make decisions in a manner that conserves diminishing cognitive resources.

The increased reliance on interorganizational collaborations (ICs) has created new challenges for leaders. They must attempt to apply leadership theories and behaviors developed primarily for leading within one organization or group to leading collaborations of multiple organizations and stakeholders. To provide insight into this issue, this study examines leadership behavior in an IC developing a strategic plan to promote changes to address public health and safety concerns related to substance abuse. Combining observations and interviews, we followed a statewide interagency taskforce in a southwestern state of the United States from its inception through completion of its strategic plan within a 10-month deadline. Findings show different leadership behaviors were integrated and evolved over time to strike a balance between decision-making effectiveness and efficiency. In particular, the findings support recent research on examining leadership behavior holistically to develop a ‘fuller full-range’ leadership perspective (Antonakis and House, 2014), especially in terms of how collectivistic and instrumental leadership should complement transformational leadership, and by demonstrating that the combinations of leadership change over time and occur at multiple levels. These findings provide guidance for future practice and research on ICs promoting change.