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Provides a business model based on the UCLA Health System and explains how other businesses can use the same system to provide excellent customer experiences and dominate their industry.

Previous studies suggest that in Alzheimer's disease (AD) the Apolipoprotein E (APOE) e4 allele is associated with greater vulnerability of medial temporal lobe structures. However, less is known about its effect on the whole cortical mantle. Here we aimed to identify APOE-related patterns of cortical atrophy in AD using an advanced computational anatomy technique. We studied 15 AD patients carriers (e4+, age: 72 +/- 10 SD years, MMSE: 20 +/- 3 SD) and 14 non-carriers (e4-, age: 69 +/- 9, MMSE: 20 +/- 5) of the e4 allele and compared them to 29 age-and-sex matched controls (age: 70 +/- 9, MMSE: 28 +/- 1). Each subject underwent a clinical evaluation, a neuropsychological battery, and high-resolution MRI. UCLA's cortical pattern matching technique was used to identify regions of local cortical atrophy. e4+ and e4- patients showed similar performance on neuropsychological tests (p > .05, t-test). Diffuse cortical atrophy was detected for both e4+ (p = .0001, permutation test) and e4- patients (p = .0001, permutation test) relative to controls, and overall gray matter loss was about 15% in each patients group. Differences in gray matter loss between carriers and non-carriers mapped to the temporal cortex and right occipital pole (20% greater loss in carriers) and to the posterior cingulate, left orbitofrontal and dorsal fronto-parietal cortex (5-15% greater loss in non-carriers). APOE effect in AD was not significant (p > .74, ANOVA), but a significant APOE by region (temporal vs fronto-parietal cortex) interaction was detected (p = .002, ANOVA), in both early and late-onset patients (p < .05, ANOVA). We conclude that the e4 allele modulates disease phenotype in AD, being associated with a pattern of differential temporal and fronto-parietal vulnerability.

Loneliness is a growing public health concern among older adults. This study examined the prevalence and correlates of loneliness among community-dwelling older adults in Taiwan and compared the performance of three loneliness measurement tools. A cross-sectional survey was conducted among adults aged ≥65 years recruited from community centers in Southern Taiwan. Loneliness was assessed using the UCLA-LS-20, UCLA-LS-3, and a single-item direct measure. Psychological and health-related variables included LSNS-6, GDS-15, GAD-7, and EQ-5D-5L. Multivariable logistic regression was used to identify factors associated with loneliness, and ROC analysis was performed to compare the discriminatory performance of the three instruments. Among 186 participants, the prevalence of loneliness ranged from 18% to 27% depending on the instrument used. Higher GDS-15 scores were consistently associated with loneliness across all models. Other associated factors included social network size, living arrangement, anxiety symptoms, and self-rated health. The models using the UCLA-LS-3 and single-item measure showed high AUC values (0.9005 and 0.8988, respectively), and the model using the UCLA-LS-20 also demonstrated good model-specific predictive performance (AUC=0.8123). Loneliness is common among older adults in Taiwan. Brief measures, such as the UCLA-LS-3 and single-item question, may be practical for community-based loneliness screening, and the UCLA-LS-20 remains useful for more comprehensive assessment.

The Electron Loss and Fields Investigation with a Spatio-Temporal Ambiguity-Resolving option (ELFIN-STAR, or heretoforth simply: ELFIN) mission comprises two identical 3-Unit (3U) CubeSats on a polar (∼93 ∘ inclination), nearly circular, low-Earth (∼450 km altitude) orbit. Launched on September 15, 2018, ELFIN is expected to have a >2.5 year lifetime. Its primary science objective is to resolve the mechanism of storm-time relativistic electron precipitation, for which electromagnetic ion cyclotron (EMIC) waves are a prime candidate. From its ionospheric vantage point, ELFIN uses its unique pitch-angle-resolving capability to determine whether measured relativistic electron pitch-angle and energy spectra within the loss cone bear the characteristic signatures of scattering by EMIC waves or whether such scattering may be due to other processes. Pairing identical ELFIN satellites with slowly-variable along-track separation allows disambiguation of spatial and temporal evolution of the precipitation over minutes-to-tens-of-minutes timescales, faster than the orbit period of a single low-altitude satellite (T orbit ∼ 90 min). Each satellite carries an energetic particle detector for electrons (EPDE) that measures 50 keV to 5 MeV electrons with Δ E/E < 40% and a fluxgate magnetometer (FGM) on a ∼72 cm boom that measures magnetic field waves (e.g., EMIC waves) in the range from DC to 5 Hz Nyquist (nominally) with <0.3 nT/sqrt(Hz) noise at 1 Hz. The spinning satellites (T spin ∼ 3 s) are equipped with magnetorquers (air coils) that permit spin-up or -down and reorientation maneuvers. Using those, the spin axis is placed normal to the orbit plane (nominally), allowing full pitch-angle resolution twice per spin. An energetic particle detector for ions (EPDI) measures 250 keV – 5 MeV ions, addressing secondary science. Funded initially by CalSpace and the University Nanosat Program, ELFIN was selected for flight with joint support from NSF and NASA between 2014 and 2018 and launched by the ELaNa XVIII program on a Delta II rocket (with IceSatII as the primary). Mission operations are currently funded by NASA. Working under experienced UCLA mentors, with advice from The Aerospace Corporation and NASA personnel, more than 250 undergraduates have matured the ELFIN implementation strategy; developed the instruments, satellite, and ground systems and operate the two satellites. ELFIN’s already high potential for cutting-edge science return is compounded by concurrent equatorial Heliophysics missions (THEMIS, Arase, Van Allen Probes, MMS) and ground stations. ELFIN’s integrated data analysis approach, rapid dissemination strategies via the SPace Environment Data Analysis System (SPEDAS), and data coordination with the Heliophysics/Geospace System Observatory (H/GSO) optimize science yield, enabling the widest community benefits. Several storm-time events have already been captured and are presented herein to demonstrate ELFIN’s data analysis methods and potential. These form the basis of on-going studies to resolve the primary mission science objective. Broad energy precipitation events, precipitation bands, and microbursts, clearly seen both at dawn and dusk, extend from tens of keV to >1 MeV. This broad energy range of precipitation indicates that multiple waves are providing scattering concurrently. Many observed events show significant backscattered fluxes, which in the past were hard to resolve by equatorial spacecraft or non-pitch-angle-resolving ionospheric missions. These observations suggest that the ionosphere plays a significant role in modifying magnetospheric electron fluxes and wave-particle interactions. Routine data captures starting in February 2020 and lasting for at least another year, approximately the remainder of the mission lifetime, are expected to provide a very rich dataset to address questions even beyond the primary mission science objective.

This systematic review assessed the psychometric properties and the cross-cultural adaptation of the University of California and Los Angeles Loneliness scale (UCLA-LS) in adults. A systematic search of four electronic databases (PubMed, EMBASE, Scopus, and PsycINFO) was conducted from inception until March 2021. We followed the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines for data extraction and evidence synthesis. Eighty-one studies assessed the validity and reliability of the UCLA-LS, translated into many languages, and applied across several countries/societies. Three versions of the 20-item and nine short versions of the UCLA-LS with 3 to 20 questions were identified. High-quality evidence supported the internal structure of the UCLAs: 4, 6, 7 and 10, while low-to moderate-quality evidence supported the construct validity of the UCLAs: 3, 4, 6, 8, 16 and 20. Moderate-quality evidence supported the test-retest reliability of version 3 UCLA-20 with excellent interclass coefficients values of 0.76-0.93. The UCLAs: 4, 6, 7 and 10 had the most robust internal structure and may therefore be the most useful for informing clinicians and social psychologists engaged in assisting those with loneliness.

Background: Thyroid eye disease (TED) is the most common extrathyroidal manifestation of Graves’ disease and a major cause of morbidity. Management of active, moderate-to-severe thyroid eye disease remains challenging due to clinical heterogeneity, a variable response to glucocorticoids, and an evolving evidence base for alternative therapies. Although international guidelines provide general recommendations, uncertainty persists regarding the role of biologics, immunosuppressants, and local interventions. Objective: To assess the appropriateness and necessity of medical therapies for active, moderate-to-severe thyroid eye disease using the RAND/UCLA Appropriateness Method, integrating systematic evidence with expert consensus. Methods: A systematic review of randomized trials, meta-analyses, systematic reviews, and observational studies was conducted following PRISMA standards. A multidisciplinary panel (n=10) rated 14 clinical scenarios across 238 intervention–scenario pairs in three rounds using a 9-point scale. Appropriateness was defined by median scores and the interpercentile range; necessity was evaluated for appropriate interventions according to RAND/UCLA criteria. Results: Intravenous glucocorticoids were consistently rated as necessary as a first-line therapy. Teprotumumab and tocilizumab were considered appropriate in multiple scenarios, with teprotumumab frequently meeting necessity criteria. Mycophenolate was appropriate but not necessary, reflecting concerns about the robustness of the evidence and its modest efficacy. Rituximab was rated conservatively due to heterogeneous evidence and safety concerns, including dysthyroid optic neuropathy. Local therapies, such as periocular triamcinolone and botulinum toxin, were appropriate in several scenarios and necessary in selected cases. Conclusions: Intravenous glucocorticoids remain the cornerstone of TED management. This consensus clarifies the role of emerging therapies and provides context-specific recommendations that complement existing guidelines.

Ethn Dis. 2022;32(3):239-242; doi:10.18865/ed.32.3.239

The UCLA Loneliness Scale (Version 3; UCLA-LSV3) is widely used for assessing loneliness. Nevertheless, the validity of this scale for assessing loneliness in individuals with schizophrenia or schizoaffective disorder has not been determined. Additionally, studies validating the eight-item and three-item versions of UCLA-LSV3 have not included individuals with severe mental illness; therefore, whether the short versions are comparable to the full 20-item version of UCLA-LSV3 for this population is unclear. The present study examined the unidimensional structure, internal consistency, concurrent validity, and test–retest reliability of the Chinese versions of UCLA-LSV3 (i.e., 20-item, 8-item, and 3-item versions) to determine which version is most appropriate for assessing loneliness in individuals with schizophrenia or schizoaffective disorder in Taiwan. A total of 300 participants (267 with schizophrenia and 33 with schizoaffective disorder) completed the scales, comprising UCLA-LSV3, the Center for Epidemiological Studies Depression Scale (CES-D), the suicidality module of the Kiddie Schedule for Affective Disorders and Schizophrenia–Epidemiological Version (K-SADS-E), and the family and peer Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) index. Construct validity was evaluated through confirmatory factor analysis. The three versions of UCLA-LSV3 were compared with the CES-D, the suicidality module of the K-SADS-E, and the family and peer APGAR index to establish concurrent validity. The results indicated that all three versions of UCLA-LSV3 exhibited acceptable to satisfactory psychometric properties in terms of unidimensional constructs, concurrent validity, and test–retest reliability. The full version of UCLA-LSV3 had the best performance, followed by the eight-item version and the three-item version. Moreover, the three versions had relatively strong associations with each other. Therefore, when deliberating which version of UCLA-LSV3 is the best choice for assessing loneliness in individuals with schizophrenia or schizoaffective disorder, healthcare providers and therapists should consider time availability and practicality.

This study addresses the challenge of teaching genetics effectively to high school students, a topic known to be particularly challenging. Leveraging the growing importance of artificial intelligence (AI) in education, the research explores the perspectives, attitudes, and behavioral intentions of pre-service teachers regarding the integration of AI-based applications in high school genetics education. As these pre-service teachers, commonly denoted as digital natives, are expected to seamlessly integrate technology into their future classrooms in our technology-dependent society, understanding their viewpoints is crucial. The research involved 90 teacher candidates specializing in biology from Nigerian higher education institutions. Employing the Theory of Planned Behavior, survey responses were analyzed using structural equation modeling and independent sample t-test methods. The results indicate that perceived usefulness and subjective norms are significant predictors of AI use, with subjective norms strongly influencing pre-service teachers' behavioral intentions. Notably, perceived behavioral control does not significantly predict intentions, paralleling the observation that perceive usefulness does not guarantee AI adoption. Gender differentially affects subjective norms, particularly among female pre-service teachers, while no significant gender differences are observed in other variables, suggesting comparable attitudes. The study underscores the pivotal role of attitudes and social norms in shaping pre-service teachers' decisions regarding AI technology integration. Detailed discussions on implications, limitations, and potential future research directions are also discussed.