Aim: Social engagement is associated with preserved cognition in older adults. We evaluated the predictive value of structural and functional social network characteristics for cognitive resilience among adults aged ≥ 80 years using machine learning models. Methods: We included Framingham Heart Study Offspring participants aged ≥ 80 years and free of dementia at Exam 8 (2005–2008). Eleven social network measures were assessed using the Berkman-Syme Social Network Index. Cognitive resilience was defined as remaining dementia-free through December 2024. Minimum Redundancy Maximum Relevance (mRMR) identified informative features, and principal component analysis (PCA) characterized their multidimensional structure. Logistic regression, classification and regression trees, random forest, XGBoost, and LightGBM were evaluated using five-fold cross-validation. Performance was assessed using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value, F1 score, and balanced accuracy. SHapley Additive exPlanations (SHAP) was used to interpret the best-performing model. Results: The sample of 141 participants consisted of 56.7% females with a median age of 82 years. In total, 107 participants were cognitively resilient. The most frequently selected feature was “Feeling love and affection”. PCA identified one component reflecting overall social connectedness and support (PC1) and another reflecting interaction with friends and social activities (PC2). LightGBM including PC1 and PC2 had the highest discrimination (AUC = 0.694; 95% CI: 0.456–0.897), with PPV = 0.850, F1 = 0.654, and balanced accuracy = 0.616. Within LightGBM, AUC increased from 0.613 to 0.694 after adding PC1 and PC2. SHAP ranked PC1 and PC2 among the four most influential predictors. Conclusions: Social network characteristics reflecting perceived love, emotional support, family connections, and social interaction may provide incremental predictive information for cognitive resilience. However, overall predictive performance was modest, and larger, more diverse studies incorporating broader biological, behavioral, and clinical factors are needed.
Aim: Novel approaches are needed to expand access to non-pharmacological pain management options. This study’s objective was to test and evaluate the acceptability, feasibility, and treatment effects of videoconference-based pain consultations among adults prescribed opioids for chronic pain. Methods: A one-group pre-post pilot feasibility design was used to recruit adults with a chronic pain diagnosis. Convenience sampling was restricted to United States (U.S.) residents in Washington State. Three videoconference-based 45-minute sessions were offered from participants’ choice of two non-pharmacological modalities delivered by yoga, massage, chiropractic, and physical therapists. Six sessions were offered in total per participant (once weekly for six weeks). Pain intensity/interference, depression, anxiety, pain self-efficacy, thwarted belongingness, spiritual well-being, and opioid misuse were assessed at baseline and post-intervention using online surveys to determine whether improvements could be detected. Data were also captured on recruitment and retention as a measure of feasibility, while session attendance and satisfaction surveys measured acceptability. Results: Sixteen participants completed 92 treatment modality sessions. Yoga therapy was the most selected option (n = 11), followed by physical therapy (n = 9), massage therapy (n = 8), and chiropractic therapy (n = 4). Attendance was 95% at the scheduled sessions. Significant improvements from baseline to week six were found in pain intensity and interference, depressive symptoms, and thwarted belongingness. Conclusions: Multidisciplinary virtual pain consultations delivered via videoconferencing technology served as a feasible option to access complementary and integrative therapies. Improvements were detected in pain-related and psychosocial outcomes. Structured virtual approaches may represent a scalable strategy to expand non-pharmacologic treatment options for adults with chronic pain. Protocol for this study was registered a priori through Clinical Trials Network (#NCT05098158).
Aim: To compare centre and peripheral tapping techniques during lateral window sinus lift preparation with respect to residual peripheral bone rim thickness and the frequency of Schneiderian membrane perforation in an ex vivo goat maxilla model. Methods: Twenty goat maxillary specimens were evaluated, with both contralateral sides used, yielding 40 lateral-window preparations arranged as 20 matched pairs. One side of each specimen underwent centre tapping, and the contralateral side underwent peripheral tapping. Residual peripheral bone rim thickness was measured at six predefined locations following window mobilization, and Schneiderian membrane perforation was recorded as present or absent. Residual bone-rim thickness was summarized as mean ± standard deviation (SD) from the available measurements, while membrane perforation was evaluated descriptively. Results: Peripheral tapping demonstrated greater mean residual peripheral bone rim thickness than centre tapping at all six measurement sites. Based on recalculation from the available group-level summary data, significant differences were observed at the superio-anterior (0.26 ± 0.02 mm vs. 0.14 ± 0.01 mm; p < 0.001), superior (0.27 ± 0.01 mm vs. 0.24 ± 0.01 mm; p < 0.001), superio-posterior (0.12 ± 0.02 mm vs. 0.10 ± 0.02 mm; p = 0.007), inferior (0.13 ± 0.02 mm vs. 0.09 ± 0.02 mm; p < 0.001), and inferio-anterior (0.19 ± 0.02 mm vs. 0.09 ± 0.02 mm; p < 0.001) regions. The inferio-posterior difference was not statistically significant (0.13 ± 0.01 mm vs. 0.12 ± 0.02 mm; p = 0.165). Schneiderian membrane perforation was observed in 8/20 (40.0%) centre-tapping preparations and 4/20 (20.0%) peripheral-tapping preparations. Conclusions: Peripheral tapping was associated with greater residual peripheral bone-rim thickness at most evaluated sites and a numerically lower observed frequency of Schneiderian membrane perforation than centre tapping. The findings support peripheral tapping as a promising favourable technical profile that merits further paired experimental evaluation.
Hypertension is one of the leading causes of death worldwide, and has been increasing in prevalence. A subset of hypertensive patients has resistant hypertension: blood pressure above goal despite taking three or more antihypertensive medications. While the diagnosis of true resistant hypertension requires medication adherence, many studies have found suboptimal adherence or complete nonadherence in resistant hypertensive patients. There are many factors that affect medication adherence, some more prevalent in the treatment of resistant and refractory hypertension, such as complex and expensive medication regimens. The greatest hurdle in preventing nonadherence is accurately measuring and monitoring adherence. There are various methods of monitoring medication adherence, both directly and indirectly, including questionnaires, pill counting, and blood plasma or urinary testing. These methods vary substantially in accuracy and common usage. This review covers the factors that affect adherence in resistant hypertensive patients and the methods used to assess adherence in these patients.
Patients with acute heart failure show substantial variation in natriuretic and decongestive responses to loop diuretics, yet the physiological basis of this heterogeneity remains incompletely understood. Chloride status has emerged as a candidate marker of cardiorenal response, supported by associations with neurohormonal activation, diuretic efficiency and residual congestion, together with chloride-sensitive WNK signalling. Separately, the apelinergic system exerts acute renal and haemodynamic effects in humans, while experimental studies indicate that apelin-receptor signalling depends on mechanical and molecular context. No study, however, has directly tested whether chloride state modifies apelin responsiveness, and acute sodium depletion or angiotensin II exposure did not attenuate apelin responses in controlled human studies. This Perspective proposes that chloride state may modify apelin responsiveness when chloride-conditioned renal physiology coexists with persistent myocardial loading. Chloride is therefore treated as a continuous, longitudinal state variable rather than a therapeutic target or surrogate for receptor function. We also define the competing biomarker and causal interpretations, propose research measurements and plausible sensitivity thresholds, and outline a staged translational testing framework. Support would require incremental information beyond sodium and established risk measures, a reproducible mechanistic interaction, and state-dependent variation in directly measured agonist response. Confirmation could inform physiological enrichment of future apelin-agonist trials, whereas failure could retain chloride as a marker of decongestive physiology rather than an apelin-modifying mechanism.
