In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.

A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.

We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.

The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.

Approximately 6.5 million Americans ages 65 and older have Alzheimer’s disease and related dementias, a prevalence projected to triple by 2060. While subtle impairment in cognition and instrumental activities of daily living (IADLs) arises in the mild cognitive impairment (MCI) phase, early detection of these insidious changes is difficult to capture given limitations. Traditional IADL assessments administered infrequently are less sensitive to early MCI and not conducive to tracking subtle changes that precede significant declines. Continuous passive monitoring of IADLs using sensors and software in home environments is a promising alternative. The purpose of this study was to determine which remotely monitored IADLs best distinguish between MCI and normal cognition.

Participants were 65 years or older, independently community-dwelling, and had at least one daily medication and home internet access. Clinical assessments were performed at baseline. Electronic pillboxes (MedTracker) and computer software (Worktime) measured daily medication and computer habits using the Oregon Center for Aging and Technology (ORCATECH) platform. The Survey for Memory, Attention, and Reaction Time (SMART; Trail A, Trail B, and Stroop Tests) is a self-administered digital cognitive assessment that was deployed monthly. IADL data was aggregated for each participant at baseline (first 90 days) in each domain and various features developed for each. The receiver operating characteristic area under the curve (ROC-AUC) was calculated for each feature.

Traditional IADL Questionnaires.

At baseline, 103 participants (normal n = 59, Mage = 73.6±5.5; MCI n = 44, Mage = 76.0±6.1) completed three functional questionnaires (Functional Activities Questionnaire; Measurement of Everyday Cognition (ECog), both self-report and informant). The Informant ECog demonstrated the highest AUC (72% AUC, p = <.001).

Remotely monitored in-home IADLs and self-administered brief online cognitive test performance.

Eighty-four had medication data (normal n = 48, Mage = 73.2±5.4; MCI n = 36, Mage = 75.6±6.9). Four features related to pillbox-use frequency (73% AUC) and four features related to pillbox-use time (62% AUC) were developed. The discrepancy between self-reported frequency of use versus actual use was the most discriminating (67% AUC, p = .03).

Sixty-six had computer data (normal n = 38, Mage = 73.6±6.1; MCI n = 28, Mage = 76.6±6.8). Average usage time showed 64% AUC (p = .048) and usage variability showed 60% AUC (p = .18).

One hundred and two completed the SMART (normal n = 59, Mage = 73.6±5.5; MCI n = 43, Mage = 75.9±6.2). Eleven features related to survey completion time demonstrated 80% AUC in discriminating cognition. Eleven features related to the number of clicks during the survey demonstrated 70% AUC. Lastly, seven mouse movement features demonstrated 71% AUC.

Pillbox use frequency combined features and self-administered brief online cognitive test combined features (e.g., completion times, mouse cursor movements) have acceptable to excellent ability to discriminate between normal cognition and MCI and are relatively comparable to informant rated IADL questionnaires. General computer usage habits demonstrated lower discriminatory ability. Our approach has applied implications for detecting and tracking older adults’ declining cognition and function in real world contexts.

Subjective cognitive decline (SCD, i.e., perceived cognitive decline without neuropsychological deficits) is associated with Alzheimer’s disease pathology and increased risk for cognitive impairment but is heterogenous in etiology and has been linked to other factors including personality and depression. Mental wellbeing (i.e., the perception and functioning of social, emotional, and health-related aspects of one’s life) has been associated with subjective memory complaints, but its relationship with other subjective cognitive domains is poorly understood. Further characterizing the relationship between mental wellbeing and SCD could refine understanding of SCD and inform development of interventions that prevent progression to objective cognitive decline. This study aimed to describe the relationship between mental wellbeing and subjective decline in multiple cognitive domains and examine whether this relationship differs between older adults with normal cognition and those with mild cognitive impairment (MCI).

Community-dwelling older adults (normal: n = 58, Mage = 73.7±5.6; MCI: n = 43, Mage = 75.9±6.1) completed the Everyday Cognition scale, a validated self-report measure of SCD, and the RAND-36 Health Survey, a validated self-report measure of health-related quality of life which includes a mental wellbeing subscale. Spearman’s rank correlations were conducted between self-reported mental wellbeing and each self-reported cognitive domain (i.e., memory, language, visuospatial, and executive function) for the Normal Cognition and MCI groups.

Worse mental wellbeing was associated with worse subjective language and executive function in the normal group, rs(56) = -.42, p =.001; rs(56) = -.37, p =.005, but not for the MCI group, rs(41) = -.23, p =.15; rs(41) = -.12, p =.46. Worse mental wellbeing was associated with worse subjective visuospatial function in the MCI group, rs(41) = -.39, p =.009, but not in the normal group, rs(56) = -.11, p =.39. For both groups, worse mental wellbeing was associated with worse subjective memory, rs(56) = -.45, p < .001; rs(41) = -.37, p =.02. While this correlation was greater in the normal group, the difference was not significant (z = 0.38, p =.71).

These results suggest that perceptions of mental wellbeing are related to perceptions of cognitive decline in multiple domains, and that the specific domains involved differ between normal and MCI groups. The differential associations may mean perception of specific cognitive domains more strongly affect mental wellbeing, or mental wellbeing more acutely influences perception of those domains. The overall observed relationship between SCD and mental wellbeing may have several explanations: the impact of broader health perceptions may extend to cognitive perception, behavioral changes associated with poor wellbeing may reduce subjective cognitive function, or worse subjective cognitive function may lead to negative experiences of wellbeing. Future longitudinal investigation could inform causal inferences. The more limited associations between mental wellbeing and SCD among MCI individuals may point to the role of decreased self-awareness (due to cognitive impairment) precluding detection of subtle changes in cognition or wellbeing. This study highlights the importance of better understanding mental wellbeing in experiences of SCD in both normal and MCI older adults to improve cognitive and mental health outcomes.

To describe the genomic analysis and epidemiologic response related to a slow and prolonged methicillin-resistant Staphylococcus aureus (MRSA) outbreak.

Prospective observational study.

Neonatal intensive care unit (NICU).

We conducted an epidemiologic investigation of a NICU MRSA outbreak involving serial baby and staff screening to identify opportunities for decolonization. Whole-genome sequencing was performed on MRSA isolates.

A NICU with excellent hand hygiene compliance and longstanding minimal healthcare-associated infections experienced an MRSA outbreak involving 15 babies and 6 healthcare personnel (HCP). In total, 12 cases occurred slowly over a 1-year period (mean, 30.7 days apart) followed by 3 additional cases 7 months later. Multiple progressive infection prevention interventions were implemented, including contact precautions and cohorting of MRSA-positive babies, hand hygiene observers, enhanced environmental cleaning, screening of babies and staff, and decolonization of carriers. Only decolonization of HCP found to be persistent carriers of MRSA was successful in stopping transmission and ending the outbreak. Genomic analyses identified bidirectional transmission between babies and HCP during the outbreak.

In comparison to fast outbreaks, outbreaks that are “slow and sustained” may be more common to units with strong existing infection prevention practices such that a series of breaches have to align to result in a case. We identified a slow outbreak that persisted among staff and babies and was only stopped by identifying and decolonizing persistent MRSA carriage among staff. A repeated decolonization regimen was successful in allowing previously persistent carriers to safely continue work duties.

To conduct international comparisons of self-reports, collateral reports, and cross-informant agreement regarding older adult psychopathology.

We compared self-ratings of problems (e.g. I cry a lot) and personal strengths (e.g. I like to help others) for 10,686 adults aged 60–102 years from 19 societies and collateral ratings for 7,065 of these adults from 12 societies.

Data were obtained via the Older Adult Self-Report (OASR) and the Older Adult Behavior Checklist (OABCL; Achenbach et al., 2004).

Cronbach’s alphas were .76 (OASR) and .80 (OABCL) averaged across societies. Across societies, 27 of the 30 problem items with the highest mean ratings and 28 of the 30 items with the lowest mean ratings were the same on the OASR and the OABCL. Q correlations between the means of the 0–1–2 ratings for the 113 problem items averaged across all pairs of societies yielded means of .77 (OASR) and .78 (OABCL). For the OASR and OABCL, respectively, analyses of variance (ANOVAs) yielded effect sizes (ESs) for society of 15% and 18% for Total Problems and 42% and 31% for Personal Strengths, respectively. For 5,584 cross-informant dyads in 12 societies, cross-informant correlations averaged across societies were .68 for Total Problems and .58 for Personal Strengths. Mixed-model ANOVAs yielded large effects for society on both Total Problems (ES = 17%) and Personal Strengths (ES = 36%).

The OASR and OABCL are efficient, low-cost, easily administered mental health assessments that can be used internationally to screen for many problems and strengths.

Traumatic events are associated with increased risk of psychotic experiences, but it is unclear whether this association is explained by mental disorders prior to psychotic experience onset.

To investigate the associations between traumatic events and subsequent psychotic experience onset after adjusting for post-traumatic stress disorder and other mental disorders.

We assessed 29 traumatic event types and psychotic experiences from the World Mental Health surveys and examined the associations of traumatic events with subsequent psychotic experience onset with and without adjustments for mental disorders.

Respondents with any traumatic events had three times the odds of other respondents of subsequently developing psychotic experiences (OR=3.1, 95% CI 2.7–3.7), with variability in strength of association across traumatic event types. These associations persisted after adjustment for mental disorders.

Exposure to traumatic events predicts subsequent onset of psychotic experiences even after adjusting for comorbid mental disorders.