Pennsylvania Department of Aging

Digital subtraction angiography (DSA) is the gold standard modality for diagnostics and guidance for interventional procedures. Spectral imaging has previously been explored for DSA, but severe noise amplification from material decomposition has impeded clinical adoption. We present a novel joint processing strategy that leverages both temporal and spectral information for material decomposition to address this issue. We develop a model-based material decomposition approach that utilizes the pre- and post-contrast images simultaneously for material estimation. Performance was evaluated on a small-vessel phantom on a test bench with a photon-counting detector. Joint processing was compared with temporal subtraction and previously proposed spectral DSA techniques including hybrid subtraction and conventional three-material decomposition. Additional simulation was performed to investigate performance with perfectly calibrated spectral response and sensitivity to patient motion. The improved conditioning of the proposed method effectively reduces bias and noise in the spectral results and allows three-material decomposition with dual-energy spectral measurements. The method achieved more than an order of magnitude variance reduction compared to previously proposed spectral DSA techniques. Compared to temporal subtraction, a mean variance reduction of 23.9% was achieved in simulation and 10.8% in experimental data. The degree of reduction is object-dependent. Noise reduction achieved in physical experiments is slightly lower than that in simulation, likely due to bias from imperfect spectral calibration. The method is equally sensitive to motion compared to temporal subtraction. The proposed method addresses a major image quality challenge limiting previous approaches and outperforms temporal subtraction. Such improvements facilitate the clinical translation of spectral angiography.

Abstract The Pennsylvania Department on Aging (PDA) is developing a “Master Plan for Older Adults” called “Aging Our Way.” The plan will help guide policies and programs for the next 10 years. Agency leadership turned to the University of Pittsburgh to conduct a statewide needs assessment survey as part of a broad stakeholder engagement process that involved community meetings in all 67 counties. The University conducted a statewide telephone survey drawing on the Age-Friendly Community model. A sample of adults age 60 and older was stratified into eight regions to assure that the entire state was represented. To reach non-English speaking adults and disabled adults who might not respond by telephone, a web-based version of the survey was developed and translated into Chinese, Spanish and Russian and distributed via email to stakeholder groups. Paper versions in were mailed to community-based organizations to reach individuals who were not able to access the internet. The telephone survey results (n=900) were weighted to match the 2021 American Community Survey. The web-based survey results (n=6950) are reported separately. Findings were presented to the Long-Term Care Council, a stakeholder group that is convened by the PDA to advise on policy. The Council was formed into several subcommittees that addressed different policy topics (e.g., housing, transportation). The draft report developed by the Council was shared with the University team to develop objectives that could be measured by repeating the survey. The overall collaboration between the University and the PDA led to a strong, empirically based report.

Deep learning methods for accelerated MRI achieve state-ofthe-art results but largely ignore additional speedups possible with noncartesian sampling trajectories. To address this gap, we created a generative diffusion model-based reconstruction algorithm for multi-coil highly undersampled spiral MRI. This model uses conditioning during training as well as frequency-based guidance to ensure consistency between images and measurements. Evaluated on retrospective data, we show high quality (structural similarity >0.87) in reconstructed images with ultrafast scan times (0.02 seconds for a 2D image). We use this algorithm to identify a set of optimal variable-density spiral trajectories and show large improvements in image quality compared to conventional reconstruction using the non-uniform fast Fourier transform. By combining efficient spiral sampling trajectories, multicoil imaging, and deep learning reconstruction, these methods could enable the extremely high acceleration factors needed for real-time 3D imaging.

Proper functioning of a variety of complex systems relies on flexible communication between different units. Yet, how context-dependent information propagation routes arise over a relatively static network remains largely mysterious. Inspired by the observation that neuronal communication is regulated by oscillations in the brain, we propose a dynamical information transmission framework based on the Kuramoto-oscillator network. We analytically show that multistability is a mechanism for flexible information routing. We define a novel metric, the flexibility index, to measure the communication plasticity of information channels in networks. Sufficient conditions on the network parameters are obtained for channels to be flexible. We also use several examples to illustrate how information can be routed to different parts of a network via switching between multiple stable states.

Specialty palliative care for hospitalized patients with dementia is widely recommended and may improve outcomes, yet rates of consultation remain low. We sought to describe hospitalists' decision-making regarding palliative care consultation for patients with dementia. Descriptive qualitative study. Seven hospitals within a national nonprofit health system. Hospitalist physicians. Individual semistructured interviews. We used thematic analysis to explore factors that influence hospitalists' decision to consult palliative care for patients with dementia. A total of 171 hospitalists were eligible to participate, and 28 (16%) were interviewed; 17 (61%) were male, 16 (57%) were white, and 18 (64%) were in practice less than 10 years. Overall, hospitalists' decisions to consult palliative care for patients with dementia were influenced by multiple factors across four themes: patient, family caregiver, hospitalist, and organization. Consultation was typically only considered for patients with advanced disease, particularly those receiving aggressive care or with family communication needs (navigating conflicts around goals of care and improving disease and prognostic understanding). Hospitalists' limited time and, for some, a lack of confidence in palliative care skills were strong drivers of consultation. Palliative care needs notwithstanding, most hospitalists would not request consultation if they perceived families would be resistant to it or had limited availability or involvement in caregiving. Additional barriers to referral at the organization level included a hospital culture that conflated palliative and end-of-life care and busy palliative care teams at some hospitals. Hospitalists described a complex consultation decision process for involving palliative care specialists in the care of patients with dementia. Systematic identification of hospitalized patients with dementia most likely to benefit from palliative care consultation and strategies to overcome modifiable family and organization barriers are needed. J Am Geriatr Soc 68:2365-2372, 2020.

This study aimed to explore the longitudinal, 6-month symptom course of older adults newly started on an antidepressant or anxiolytic by non-psychiatrist physicians and enrolled in a care management program. This is a naturalistic cohort study of older adults (age ≥65 years) receiving pharmacotherapy and telephone-based care management. Participants are non-institutionalized adults participating in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly who completed telephone-based clinical assessments including demographic data, self-report on history of psychiatric treatment and adherence, and standardized symptom scales. A total of 162 participants with an average age of 77.2 years (SD 6.8) were followed and, for analysis, split into two groups by PHQ-9 score: 75 (46.3%) scoring 0-4 (minimally symptomatic group, MSG) and 87 (53.7%) scoring ≥5 (symptomatic group, SG). Over 6 months, the SG improved with PHQ-9 scores beginning on average at 10.0 (SD 4.6) and falling to 5.4 (SD 4.2) (F(1, 86) = 29.53, p < 0.0001). The MSG had no significant change in depressive symptoms. Emotional health as measured by SF-12 Mental Composite Score mirrored the PHQ-9 change and lack thereof in the SG and MSG, respectively. No clinical or demographic features were associated with symptom improvement in the SG although they were more likely to report medication adherence (66.7% vs. 44.0%, χ(2) (1) = 8.4, p = 0.0037) compared with the MSG. Participation of symptomatic older adults initiated on psychotropic medication in a telephone-based care management program was associated with improvement in depressive symptoms and overall emotional well-being, notable findings given participants' advanced age, state-wide distribution, and history of limited utilization of mental health care.