Long term care for older people is a highly regulated sector providing accommodation, health, and social care to vulnerable older adults. Older adults in New Zealand are among the highest users of long term care services globally. Traditionally those requiring specialist care for dementia are housed apart from other residents. In an example of organizational innovation, 1 provider relocated residents to a secure village where residents requiring specialist dementia care would be desegregated. We utilized a critical realist case study to explain the role of intersectoral collaboration among government agencies in supporting the transition while managing risk and ensuring regulatory compliance.

OBJECTIVE: Typhoon Hagibis struck Japan on October 12, 2019. This study documents and characterizes deaths caused by Hagibis and helps identify strategies to reduce mortality in future disasters.
METHODS: Japanese residents, who were killed by Typhoon Hagibis, as reported by Japan\'s Fire and Disaster Management Agency, were considered for the study. Details were collected from mainstream Japanese media, and flooding data from hazard maps published by local municipalities.
RESULTS: Out of the 99 total fatalities, 65 (73.0%) were aged 65 years or above. Among those who drowned indoors (20), 18 (90.0%) lived in high-risk areas of flooding, and their bodies were found on the first floor of their residences. A total of 10 (55.6%) out of the 18 fatalities lived in homes with 2 or more floors, indicating that they could have moved upstairs to avoid the floodwater. However, 6 (33.3%) could not do so due to existing health issues.
CONCLUSIONS: Relatively elderly people, particularly those in areas at high risk of flooding, were most affected. Seeking higher ground is a standard safety measure in times of flooding, but this may not be possible for everyone depending on their health status, structure of their residence, and the depth of floodwaters.

Primary effusion lymphoma (PEL) is a very rare non-Hodgkin lymphoma caused by human herpesvirus-8 (HHV8) that grows in liquid phase within body cavities. The diagnosis of PEL is based on cytology but requires confirmatory ancillary tests. PEL occurs mainly in association with HIV infection. This study describes 9 cases of PEL in HIV-negative patients and compares their characteristics with 10 HIV-associated cases of PEL diagnosed at a single institution in Italy between 1995 and 2019.
Clinical records were reviewed for demographic data, comorbidities, laboratory abnormalities, and outcome. PEL samples were evaluated for cytomorphology, immunophenotype, immunoglobulin (IG)/T cell receptor (TR) rearrangements, and HHV8 and Epstein-Barr virus (EBV) viral loads in effusion supernatants.
HIV-unrelated PEL occurred in 8 elderly patients (7 men, 1 woman) and 1 young adult with primary antibody deficiency. Cytology revealed HHV8-positive lymphoma cells lacking B/T cell antigens and exhibiting 2 cell patterns (polymorphous or monotonous). IG was clonally rearranged in all cases; aberrant TRG occurred in 2 cases. Effusion supernatants had more than 106 HHV8 DNA copies per mL and variable loads of EBV DNA. Compared with HIV-associated PEL, the HIV-negative cohort was characterized by older age, less frequent association with Kaposi sarcoma and/or multicentric Castleman disease, comparable but less abnormal laboratory parameters, and a nonsignificant survival benefit. PEL cases with low apoptosis were associated with better prognosis.
To the best of our knowledge, our case series of HIV-unrelated PEL is the largest thus far, expands the spectrum of cytological findings, and supports the need for a multidisciplinary approach in the diagnostic workup.

Research in younger patients with medically unexplained symptoms (MUS) has shown impairments in social functioning, such as loneliness and a reduced quality of the patient-doctor relationship. As far as we know, no studies have been performed on social functioning in older MUS patients; self-reported care needs of older MUS patients remain unknown.
To explore social characteristics and care needs of older persons with chronic MUS, when compared to older persons with chronic medically explained symptoms (MES).
Patient characteristics of 107 older persons (>60 years) with chronic MUS were compared to 150 older persons with chronic MES in a case-control design. Participants were recruited via advertisements, general practices and a specialized clinic. All participants completed questionnaires on social functioning; the Camberwell Assessment of Need for the Elderly was used to draw up care needs. Linear regression analyses were performed to explore the association between social characteristics and group (MUS/MES), adjusted for demographic and physical determinants. Multiple chi-square tests were performed to detect between-group differences regarding care needs.
After adjustments, older MUS patients were slightly but significantly lonelier, reported a somewhat lower quality of their patient-doctor relationship, but reported equal social support levels when compared to MES patients. MUS patients more often reported unmet care needs regarding health and information provision about their health status.
Only small differences in social functioning were found between older MUS and MES patients. Possibly, training future doctors in giving acceptable explanations for the patient\'s complaints could improve the unmet care need of information provision in older MUS patients.