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Highlights • Mortality from COVID-19 is not affected by prescription of ACEi and / or ARBs. • Hospital length of stay is reduced in patients prescribed ACEi or ARB when diagnosed with COVID-19. • This study should provide reassurance to patients and clinicians that continuation of ACEi or ARBs is not harmful, and maybe even confer benefit in COVID-19., Objective During the COVID-19 pandemic the continuation or cessation of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) has been contentious. Mechanisms have been proposed for both beneficial and detrimental effects. Recent studies have focused on mortality with no literature having examined length of hospital stay. The aim of this study was to determine the influence of ACEi and ARBs on COVID-19 mortality and length of hospital stay. Methods COPE (COVID-19 in Older People) is a multicenter observational study including adults of all ages admitted with either laboratory or clinically confirmed COVID-19. Routinely generated hospital data were collected. Primary outcome: mortality; secondary outcomes: Day-7 mortality and length of hospital stay. A mixed-effects multivariable Cox’s proportional baseline hazards model and logistic equivalent were used. Results 1371 patients were included from eleven centres between 27th February to 25th April 2020. Median age was 74 years [IQR 61-83]. 28.6% of patients were taking an ACEi or ARB. There was no effect of ACEi or ARB on inpatient mortality (aHR=0.85, 95%CI 0.65-1.11). For those prescribed an ACEi or ARB, hospital stay was significantly reduced (aHR=1.25, 95%CI 1.02-1.54, p=0.03) and in those with hypertension the effect was stronger (aHR=1.39, 95%CI 1.09-1.77, p=0.007). Conclusions Patients and clinicians can be reassured that prescription of an ACEi or ARB at the time of COVID-19 diagnosis is not harmful. The benefit of prescription of an ACEi or ARB in reducing hospital stay is a new finding.

Background: The COVID-19 pandemic has placed unprecedented strain on health-care systems. Frailty is being used in clinical decision making for patients with COVID-19, yet the prevalence and effect of frailty in people with COVID-19 is not known. In the COVID-19 in Older PEople (COPE) study we aimed to establish the prevalence of frailty in patients with COVID-19 who were admitted to hospital and investigate its association with mortality and duration of hospital stay. Methods: This was an observational cohort study conducted at ten hospitals in the UK and one in Italy. All adults (≥18 years) admitted to participating hospitals with COVID-19 were included. Patients with incomplete hospital records were excluded. The study analysed routinely generated hospital data for patients with COVID-19. Frailty was assessed by specialist COVID-19 teams using the clinical frailty scale (CFS) and patients were grouped according to their score (1–2=fit; 3–4=vulnerable, but not frail; 5–6=initial signs of frailty but with some degree of independence; and 7–9=severe or very severe frailty). The primary outcome was in-hospital mortality (time from hospital admission to mortality and day-7 mortality). Findings: Between Feb 27, and April 28, 2020, we enrolled 1564 patients with COVID-19. The median age was 74 years (IQR 61–83); 903 (57·7%) were men and 661 (42·3%) were women; 425 (27·2%) had died at data cutoff (April 28, 2020). 772 (49·4%) were classed as frail (CFS 5–8) and 27 (1·7%) were classed as terminally ill (CFS 9). Compared with CFS 1–2, the adjusted hazard ratios for time from hospital admission to death were 1·55 (95% CI 1·00–2·41) for CFS 3–4, 1·83 (1·15–2·91) for CFS 5–6, and 2·39 (1·50–3·81) for CFS 7–9, and adjusted odds ratios for day-7 mortality were 1·22 (95% CI 0·63–2·38) for CFS 3–4, 1·62 (0·81–3·26) for CFS 5–6, and 3·12 (1·56–6·24) for CFS 7–9. Interpretation: In a large population of patients admitted to hospital with COVID-19, disease outcomes were better predicted by frailty than either age or comorbidity. Our results support the use of CFS to inform decision making about medical care in adult patients admitted to hospital with COVID-19. Funding: None.

The world's population is ageing rapidly, with significant increases in the numbers of the oldest old. This places great pressure on societies to adapt to this changing demography. Pertinent issues include provision of education and resource for long-term conditions. The priorities older people hold need to be fully understood and their contributions to society, often diverse and far-reaching, recognised with sincerity. Currently, health systems for older people can often feel reactive, fragmented and disjointed. These systems can harbour inequity and ageism, and leave both patients and health-care providers dissatisfied. Regarding the global context, the most rapidly ageing populations are in low- and middle-income countries. This partly reflects huge successes in the treatment and control of communicable diseases but gives rise to the challenge of the ‘double burden’, managing both communicable and non-communicable diseases simultaneously. Moreover, multimorbidity (suffering two or more chronic conditions) is commonplace and presents further challenges with regards to providing coordinated care. In order to harmonise effective and sustainable change, collaboration at local, national and international levels is key in order to foster a platform for learning and information sharing. Therein lies huge opportunities for countries to share their individual experiences, both past and present, to improve preparedness for global ageing.

Study Design Cross-sectional clinical measurement study. Introduction The carpometacarpal (CMC) joint of the thumb is a complex joint making accurate measurement of range of motion (ROM) challenging. There are limited normative data available to base rehabilitative decisions, which is unfortunate as this joint is frequently affected by arthritis and is critical to hand function. Purpose of the Study To provide passive ROM values for the first CMC joint and investigate the effects of age and gender. Methods Ninety-six healthy subjects were divided into 4 age groups of equal gender: 20-34, 35-49, 50-64, and 65+ years. Six-inch plastic universal goniometers were used to take 3 measurements of flexion, extension, and abduction of the dominant hand. Results Mean ROM values were 21.7 ± 6.8 degrees of flexion, 19.5 ± 5.7 degrees of extension, and 51.1 ± 5.5 degrees of abduction. There was a weak negative correlation ( r = −0.22; P = .03) between age and abduction and a difference between 2 age groups. No other relationship or difference due to age, gender, or interactions reached significance. Conclusions These normative ROM values for adults can be used by clinicians assessing patients for impaired motion at the CMC joint. No differences in flexion, extension, and abduction due to age and gender were supported, except for a small decrease (4.5°) in abduction in adults 65+ years compared with those of 35-49 years. Level of Evidence 3.

Marine Protected Areas (MPAs) are used worldwide as a management tool for the protection of marine biodiversity. To assess decadal changes in rocky reef fish assemblages following MPA protection, fish assemblages were monitored regularly in the Port Stephens-Great Lakes Marine Park (PSGLMP), New South Wales, Australia, using Baited Remote Underwater Video (BRUVs) comparing between fished and non-fished zones. Spatial and temporal heterogeneity of fish assemblages and fishery targeted species were assessed from 2006–2016 at two no-take zones at Broughton and Fingal Islands, and compared with nearby fished areas. A total of 102 species from families was observed over the study, with fish assemblage response being dependent on both the spatial scales of MPA zoning and locations within the park, and the temporal scales assessed. Five fishery targeted families, Labridae, Scorpaenidae, Sparidae, Monacanthidae and Cheilodactylidae, increased in relative abundance within no-take zones, compared with fished zones, although the response was variable among families and between locations. While abundance increased at both locations following the implementation of no-take zones, a significant zoning effect was only detected at Broughton Island, with the Labridae and Sparidae displaying the greatest increases in relative abundance within the no-take zone. This study demonstrates that the response of fish assemblages and targeted fishery families to the implementation of no-take MPA zones varies both temporally, and between locations. Differences in the assemblage response between locations are likely driven by the size and habitats within the no-take zones and these factors need to be adequately considered in MPA planning.

Solar energy conversion is inciting tremendous research efforts in many fields due to the vast potential of sunlight as a sustainable energy source. For solar energy to become widely used and become a major component of our energy mix, energy storage on large scales must be addressed and the components used must be abundant. Artificial photosynthesis to produce solar fuels holds promise as a way to convert solar energy into storable energy. Organic photocatalysts have rapidly established themselves as a viable alternative to inorganic systems. Organic photocatalyst can be prepared from inexpensive precursors and offer a synthetic versatility and tunability that can be exploited to improve efficiencies. Carbon nitride (CNx) has emerged as a leading organic photocatalyst with advantageous chemical and photo stabilities. Recombination of photogenerated electrons and holes limit the efficiency of CNx materials below levels necessary to become a viable energy production system. To improve the efficiency and key characteristics such as light harvesting, charge carrier lifetime, and interfacial rate of charge transfer, a second material is put in contact with CNx to form a heterojunction. While there are many examples of heterojunctions improving the photocatalytic activity beyond that of the isolated CNx, we are still lacking the deep understanding of charge carrier dynamics necessary to rationalize the improvements and design optimal junctions. This review covers the studies of CNx heterojunctions that have used optical methods to monitor the charge carrier dynamics. Time-resolved photoluminescence (TRPL) is the most common technique used and there are many examples that have used transient absorption spectroscopy (TAS) to probe the charge carrier dynamics. However, attempting to link the lifetime change to the activity differences does not yield a clear trend. It is likely that the reactive charges are not consistently being monitored and is obscuring the expected correlations. Both shorter and longer charge carrier lifetimes can be observed with both TRPL and TAS techniques and can be interpreted as arising from interfacial charge separation. Even when the same materials are used in the junction there is no consistency in observing a shorter or longer lifetime. The holistic view of charge carrier dynamics in CNx heterojunctions presented here intends to identify overarching themes from a wide range of CNx-containing systems and help take stock of where our current understanding stands. More specific spectral assignments and linking the observed lifetimes to certain photophysical or photochemical processes are needed to build models to help us understand the links between the charge carrier dynamics and the activity. These are crucial to develop general strategies that will lead to optimal CNx heterojunctions.

This article concerns the relationship between shame and lived experiences of welfare in Australia, a multicultural settler colony. References to shame abound in the literature dealing with lived experiences of welfare in the Global North. Scholars point to the corrosive effects of shame on the lives of welfare recipients, and the ways they resist shame. This article interrogates the relationship between shame and lived experiences of welfare anew, foregrounding the cultural specificity of welfare shame. Through two case studies—one of which deals with the receipt of social security in hyper-diverse urban Sydney and one of which deals with a punitive welfare reform experiment targeting Aboriginal Australia— we show that shame is a multi-faceted phenomenon implicated in the production of boundaries and self. We argue that the shame or, in some cases, the striking absence of shame associated with welfare is best understood by appreciating that shame is a culturally inflected and historically conditioned phenomenon. Through close description of lived experiences of welfare, we show how a psychosocial and situated conception of shame offers a complex perspective on the making of social bonds and culturally specific, spatially inflected and historically contingent conceptions of self-worth and meaning.

Due to advances in surgical and anaesthetic techniques, the volume of older people undergoing surgery has rapidly increased.[1][1] However, this patient group remains vulnerable to adverse postoperative outcomes, in particular to medical complications.[2][2] Comprehensive geriatric assessment (CGA

Parental behavioural traits can be transmitted by non-genetic mechanisms to the offspring. Although trait transmission via sperm has been extensively researched, epidemiological studies indicate the exclusive/prominent maternal transmission of many non-genetic traits. Since maternal conditions impact the offspring during gametogenesis and through fetal/early-postnatal life, the resultant phenotype is likely the aggregate of consecutive germline and somatic effects; a concept that has not been previously studied. Here, we dissected a complex maternally transmitted phenotype, reminiscent of comorbid generalized anxiety/depression, to elementary behaviours/domains and their transmission mechanisms in mice. We show that four anxiety/stress-reactive traits are transmitted via independent iterative-somatic and gametic epigenetic mechanisms across multiple generations. Somatic/gametic transmission alters DNA methylation at enhancers within synaptic genes whose functions can be linked to the behavioural traits. Traits have generation-dependent penetrance and sex specificity resulting in pleiotropy. A transmission-pathway-based concept can refine current inheritance models of psychiatric diseases and facilitate the development of better animal models and new therapeutic approaches., We are grateful for grant support R01-MH103102 and R21-MH103715 from the NIH to M.T., PO1-HD067244 and R37-HL87062 to S.S.G., 2R01-NS056049 to G.D.P., R01-HL069929, R01-AI080455 and R01-AI101406 to M.R.M. Also supported by the Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) and grants SAF2015-68346-P to F.A. and PI13/01390 to A.B., co-financed by the European Regional Development Fund. E.M. was supported in part by NIH T32-GM073546.

Older adults undergoing vascular surgery are particularly vulnerable to adverse outcomes by virtue of their vascular risk factors and medical comorbidities. This study aimed to determine the impact of daily medical liaison for patients aged 65 years and older admitted to a regional vascular surgery centre. This was a descriptive before-and-after study concerning 375 patients. The primary outcome measure was length of stay (LOS). Following intervention, we identified a reduction in mean LOS in the sample from 10.75 to 7.95 days (p = 0.635, 95% Confidence Interval [CI] 0&ndash, 5 days) with a statistically significant reduction in mean LOS for &ldquo, stranded&rdquo, patients admitted for more than seven days (mean 7.84 days reduction, p = 0.025, 95% CI for mean difference, 1.5 to 14 days). These patients did not display elevated 30-day readmission rates (12/60 to 8/72, p = 0.156, 95% CI &minus, 3% to 21%). A non-significant reduction in postoperative complications was seen in all patients in the post-intervention cohort (1.09 to 0.86 per person, p = 0.181, 95% CI &minus, 0.11 to 0.56), reaching statistical significance in emergency vascular admissions (1.81 to 0.97 complications per person, p = 0.01, mean difference = 0.84, 95% CI 0.21&ndash, 1.46). This study demonstrated reduced LOS and complications in selected older patients admitted under vascular surgery after the introduction of a daily medical liaison model. These data are amongst the first to reproduce randomised controlled trial findings in a non-trial setting. Subgroup analysis indicates that patients admitted with acute pathology and those with long LOS may benefit most from medical liaison where resources are finite.

Rheumatoid arthritis (RA) is characterized by inflammatory synovitis and is mediated by several cytokines; this includes interleukin-6, whose receptor has been successfully targeted by the humanized monoclonal antibody tocilizumab. Intravenous tocilizumab (TCZ-IV) is registered for use in RA (alone or as combination therapy), systemic juvenile idiopathic arthritis and Castleman disease. Subcutaneous tocilizumab (TCZ-SC) is a desirable alternative to existing subcutaneous biological disease modifying antirheumatic drugs (bDMARDs) targeting tumor necrosis factor. TCZ-SC efficacy has been evaluated in three randomized controlled trials. BREVACTA demonstrated superiority to placebo, and both MUSASHI and SUMMACTA demonstrated non-inferiority to TCZ-IV. TCZ-SC has a similar safety profile to TCZ-IV apart from increased rates of injection site reactions and development of anti-TCZ antibodies (the latter of uncertain clinical significance). TCZ-SC 162 mg fortnightly is equivalent to TCZ-IV 4 mg/kg fourth weekly; TCZ-SC 162 mg weekly is equivalent to TCZ-IV 8 mg/kg fourth weekly. TCZ-SC is a suitable bDMARD for RA, particularly when monotherapy is preferred.

Background: The primary school age group (aged 5–11 years) is acknowledged as a critical period in the development of physical activity patterns and healthy lifestyle behaviours. Furthermore, high ...

Introduction Germline silencing of the PD-related protein LRRK2 does not alter glutamate or dopamine release in adult mice, but some exploratory abnormalities have been reported with ageing. Contrastingly, high levels of human LRRK2 cause locomotor alterations and cognitive deficits accompanied by reduced striatal dopamine levels, with the latter also observed in G2019S mutant mice. Comparative cognitive and motor behavioral testing of LRRK2 KO, overexpressor and mutant overexpressor mice has not previously been reported. Methods Parallel, comparative behavioral characterization was performed assessing motor and cognitive abilities. Striatal antisense oligonucleotide injections were conducted to investigate the effects of acute LRRK2 silencing on behavior and dopamine fiber density. Striatal synaptosomes prepared from hG2019S mice assessed vesicular release of dopamine and its sensitivity to D2 autoreceptor stimulation. Results Genetic ablation of LRRK2 has no long-term consequences on motor or cognitive function. Consistently, no effects on behavior or dopaminergic fiber density were observed following acute striatal silencing. Conversely, 12-month OE mice show persistent locomotor deficits and worsening of cognitive abilities; whereas, hG2019S mice display early hyperactivity and effective learning and memory that progress to decreased motor and cognitive deficits at older ages. The G2019S mutation does not affect vesicular dopamine release, but decreases its sensitivity to D2-mediated inhibition. Conclusion LRRK2 silencing is well tolerated in mouse, arguing PD does not result from LRRK2 loss of function. High levels of WT and G2019S LRRK2 produce similar but temporally distinct phenotypes, potentially modeling different stages of disease progression. The data implicate gain of LRRK2 function in the pathogenesis of PD.

Background: This study examined the characteristics and associated risk and protective factors of distinct psychotic symptom profiles exhibited by marginally housed adults.

Mutations in leucine-rich repeat kinase 2 (Lrrk2) are the most common genetic cause of Parkinson's disease (PD), a neurodegenerative disorder affecting 1-2% of those65 years old. The neurophysiology of LRRK2 remains largely elusive, although protein loss suggests a role in glutamatergic synapse transmission and overexpression studies show altered dopamine release in aged mice. We show that glutamate transmission is unaltered onto striatal projection neurons (SPNs) of adult LRRK2 knockout mice and that adult animals exhibit no detectable cognitive or motor deficits. Basal synaptic transmission is also unaltered in SPNs of LRRK2 overexpressing mice, but they do exhibit clear alterations to D2-receptor-mediated short-term synaptic plasticity, behavioral hypoactivity and impaired recognition memory. These phenomena are associated with decreased striatal dopamine tone and abnormal dopamine- and cAMP-regulated phosphoprotein 32 kDa signal integration. The data suggest that LRRK2 acts at the nexus of dopamine and glutamate signaling in the adult striatum, where it regulates dopamine levels, presynaptic glutamate release via D2-dependent synaptic plasticity and dopamine-receptor signal transduction.

Sleep medication is often reported as one of the most highly used psychotropic drugs in terms of past-year prevalence. Since their use often varies according to the characteristics of individuals, it is important to better understand these particular utilization patterns.The study aims to develop a typology of sleep medication users' characteristics, including their associated mental health and substance use.Residents from the epidemiological area of south-west Montreal, Quebec aged 15 years and older responded to a questionnaire in 2009 and 2011. Among the 1822 people who participated at both T1 and T2, 306 (17%) reported use of medication to help them sleep. These participants were selected for cluster analysis based on five variables related to mental health. The identified clusters were then tested for association with sociodemographic, psychosocial, and service use characteristics.A three-cluster solution emerged: 1) older individuals without mental health problems, drug use or psychotropic medication use; 2) individuals with elevated psychological distress, drug use and low social support, and 3) individuals with mood and anxiety disorders, using services for mental health and taking two or more psychotropic medications.The results establish the significance of problems related to mental health in differentiating sleep medication users. Consideration of these differences may improve the ability of health professionals to provide services that are better suited for patients, including interventions that increase the ability to cope with stress (cluster 2) and more integrated services for those with concurrent disorders (cluster 3).

This article examine the associations between elevated exposure to psychotropic medications, presence of a diagnosis of mental illness, and sociodemographic characteristics in the adult population. A questionnaire was administered by interview to 2433 individuals aged 15 and over in the epidemiological catchment area of South-West Montreal. The determinants of psychotropic medication consumption were analyzed using bivariate analysis and multivariate logistic regression. A significant association was observed between the consumption of sleeping medications, anxiolytics, and antidepressants and being older, female, living alone, having a low level of education and income, being unemployed during the 12 months preceding the study, and presence of a mental disorder. An elevated exposure to different psychotropic medications (three or more) was reported in 3.1% of the respondants. All things being equal, this increased with age, living alone, being unemployed over the course of the last year, and presence of a mental illness. The results suggest that it is necessary to consider social isolation and prevalence of mental illness in order to contextualize the elevated exposure to psychotropic medication. Polypharmacy may indeed pose important risks if it does not follow the logic of a coherent clinical intervention.

Although nursing has a long history of service to the global community, the profession lacks a theoretical and empirical base for nurses to frame their global practice. A study using grounded theory methodology to investigate partnership and sustainability for global health led to the development of a conceptual model. Interviews were conducted with 13 global health nurse experts. Themes from the interviews were: components for engagement, mutual goal setting, cultural bridging, collaboration, capacity building, leadership, partnership, ownership, and sustainability. Next, the identified themes were reviewed in the literature in order to evaluate their conceptual relationships. Finally, careful comparison of the interview transcripts and the supporting literature led to the Conceptual Framework for Partnership and Sustainability in Global Health Nursing. The model posits that engagement and partnership must precede any planning and intervention in order to create sustainable interventions. This conceptual framework will offer nurses important guidance for global health nursing practice.

Venepuncture can be a painful and frightening experience for children. Nurses play an active role in helping them to cope with this experience and in reducing the adverse effects of venepuncture. This article explains how infants, children and their families can be supported and cared for before, during and after venepuncture.

L’article examine les associations entre l’exposition élevée aux médicaments psychotropes, la présence d’un diagnostic de trouble mental et les caractéristiques sociodémographiques chez la population adulte. Un questionnaire a été passé par entrevue auprès de 2433 personnes de 15 ans et plus dans le cadre de l’enquête ZEPSOM (zone épidémiologique du sud-ouest de Montréal). Les déterminants de leur consommation de psychotropes ont fait l’objet d’analyses bivariées et de régression logistique multivariée. Une association bivariée significative a été observée entre la consommation de somnifères, d’anxiolytiques et d’antidépresseurs et être plus âgé, être une femme, vivre seul, avoir un niveau d’instruction et de revenu faible, de ne pas avoir occupé un emploi au cours des 12 mois précédant l’enquête et présenter un trouble mental. Une exposition élevée aux différents médicaments psychotropes (trois ou plus) a été rapportée chez 3,1 % des répondants. Toutes choses étant égales, elle augmente avec l’âge, le fait de vivre seul, ne pas avoir occupé d’emploi au cours de la dernière année et de présenter un trouble mental. Les résultats suggèrent la nécessité de considérer l’isolement social et la prévalence des troubles mentaux pour contextualiser l’exposition élevée aux médicaments psychotropes puisque la polypharmacie peut présenter des risques importants si elle ne s’inscrit pas dans la logique d’un protocole d’intervention clinique cohérent., This article examine the associations between elevated exposure to psychotropic medications, presence of a diagnosis of mental illness, and sociodemographic characteristics in the adult population. A questionnaire was administered by interview to 2433 individuals aged 15 and over in the epidemiological catchment area of South-West Montreal. The determinants of psychotropic medication consumption were analyzed using bivariate analysis and multivariate logistic regression. A significant association was observed between the consumption of sleeping medications, anxiolytics, and antidepressants and being older, female, living alone, having a low level of education and income, being unemployed during the 12 months preceding the study, and presence of a mental disorder. An elevated exposure to different psychotropic medications (three or more) was reported in 3.1% of the respondants. All things being equal, this increased with age, living alone, being unemployed over the course of the last year, and presence of a mental illness. The results suggest that it is necessary to consider social isolation and prevalence of mental illness in order to contextualize the elevated exposure to psychotropic medication. Polypharmacy may indeed pose important risks if it does not follow the logic of a coherent clinical intervention.