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The burden of inflammatory bowel disease (IBD) in older adults (ie, aged over 60 years old) is increasing due to a combination of an ageing population with compounding prevalence of IBD and increasing incidence of elderly-onset (ie, onset over the age of 60 years) IBD. Despite the increasing prevalence of IBD, there is a paucity of evidence on which to base management of older adults with IBD, leading to substantial variability in care. This population is under-represented in clinical trials and has a high burden of chronic corticosteroid use, low uptake of steroid-sparing immunosuppressive agents, and high rates of unplanned health-care use and disability. Management of IBD in older adults requires carefully weighing an individual patient's risk of IBD-related complications, IBD-directed immunosuppressive therapy, and non-IBD comorbidities. A deeper understanding of biological and functional age, dynamic risk stratification strategies (including frailty-based risk assessment tools), comparative effectiveness and safety of current therapies and treatment strategies, and shared decision making to inform treatment goals and targets is needed to improve outcomes in older adults with IBD. In this Review, we discuss the epidemiology, natural history, pathophysiology, and medical and surgical management of older individuals living with IBD and identify key research gaps and approaches to address them.

While voice user interfaces offer increased accessibility due to hands-free and eyes-free interactions, older adults often have challenges such as constructing structured requests and perceiving how such devices operate. Voice-first user interfaces have the potential to address these challenges by enabling multimodal interactions. Standalone voice + touchscreen Voice Assistants (VAs), such as Echo Show, are specific types of devices that adopt such interfaces and are gaining popularity. However, the affordances of the additional touchscreen for older adults are unknown. Through a 40-day real-world deployment with older adults living independently, we present a within-subjects study (N = 16; age M = 82.5, SD = 7.77, min. = 70, max. = 97) to understand how a built-in touchscreen might benefit older adults during device setup, conducting self-report diary survey, and general uses. We found that while participants appreciated the visual outputs, they still preferred to respond via speech instead of touch. We identified six design implications that can inform future innovations of senior-friendly VAs for managing healthcare and improving quality of life., Comment: 25 pages

BackgroundRecent literature suggests that the gap in prevalence of binge drinking between men and women is closing, but little is known about sex-specific differences in trends and correlates of binge drinking among older Americans.MethodsA total of 18,794 adults, aged 65 years and older were surveyed in the 2015-2019 National Survey on Drug Use and Health. We estimated trends in prevalence of past-month binge drinking (≥5 drinks on the same occasion for men and ≥4 drinks for women), stratified by sex. Correlates of binge drinking were estimated for men and women separately, focusing on demographic characteristics, chronic diseases, past-month tobacco and cannabis use, depression, and emergency department use. Multivariable generalized linear models using Poisson and log link were used to examine associations stratified by sex.ResultsBinge drinking among older men increased from 12.8% in 2015 to 15.7% in 2019 (p=0.02) but remained stable among older women (7.6% to 7.3%, p=0.97). In adjusted models, having a college degree was associated with higher risk of binge drinking among women (adjusted prevalence ratio [aPR]=1.68, 95% CI: 1.13-2.50), but lower risk among men (aPR=0.69, 95% CI: 0.56-0.85). Men who are separated or divorced were also at higher risk (aPR=1.25, 95% CI: 1.05-1.50), but women were not. Both men and women reporting past-month use of tobacco (men aPR=1.87, 95% CI: 1.61-2.17, women aPR=2.11, 95% CI: 1.71-2.60) and cannabis (men aPR=2.05, 95% CI: 1.63-2.58, women aPR=2.77, 95% CI 2.00-3.85) were at higher risk of binge drinking.ConclusionsBinge drinking has increased among older men whereas it has remained stable among older women in the United States. Interventions should consider that although tobacco and cannabis use is associated with an increased risk of binge drinking among both older men and women, demographic correlates tend to differ by sex.

The quality of doctor-patient communication has been shown to influence treatment uptake, adherence and effectiveness in HIV medicine and elsewhere. Increasingly, it is considered essential that doctors and patients jointly participate in decisions concerning treatment. There is a growing body of literature describing joint decisionmaking and suggesting guidelines for its practice. Few of these studies, however, relate their descriptions of medical decision-making as a social process to the ways in which patterns of verbal interaction realize or foreclose on joint decision-making. -- Dominant models of medical decision-making view shared decision-making as a midpoint between enlightened paternalism and informed choice. Based on a corpus of HIV consultations audio-recorded in Sydney in the late 1990s, this thesis argues that it can be better modelled as a particular type of social process, which differs across a number of dimensions from other styles of medical decision-making, specifiable as contextual parameters of meaning. The thesis then identifies ways in which specific discursive practices realize these contextual parameters. -- A major component of the thesis focuses on agency, and a model is presented in the form of a socio-semantic network, drawing on work by van Leeuwen (1996) and others, which relates a range of grammatical features, not only transitivity patterns, to ways of construing social agency. The thesis then considers the way in which doctors and patients mobilise these and other resources for bringing together potentially conflicting points of view in framing and articulating treatment decisions. Here I draw on notions of mutual alignment (e.g., Goffman 1981) but expand the analysis of what is aligned to account for speakers' implicit discourse orientation, as well as more overt markers. -- Findings emphasise the relationship between representing and enacting agentive roles; the importance of doctors and patients mutually projecting each other's voices; and the variable and iterative character of shared decision-making. The research demonstrates how doctors and patients negotiate a complex, interactionally and symbolically mediated agency, and shows that patients often take the lead in developing more collaborative decision-making practice. There are still institutionally and socially determined limits to the degree of control patients may exercise within the consultation, many of which are of course well founded.

Clinical findings, geographic locations, laboratory diagnoses, and culture isolation of Neorickettsia spp. in Potomac horse fever (PHF) cases diagnosed in Ontario between 2015 and 2019 are described. Forty-six confirmed PHF cases occurred from late June to early September. Of 41 horses admitted to the Ontario Veterinary College, 28 (68%) survived and 13 (32%) were euthanized due to poor prognosis or financial constraints. Most cases were in southern Ontario along the Canada-USA border. Blood and fecal samples from 43 suspect PHF cases were submitted to 2 laboratories for polymerase chain reaction (PCR) testing for Neorickettsia risticii. Agreement between both laboratories for detection of N. risticii DNA was excellent for feces [κ = 0.932, 95% confidence interval (CI): 0.80 to 1], and fair for blood samples (κ = 0.494, 95% CI: 0.13 to 0.85). Neorickettia spp. were isolated from 16 of 41 (39%) blood samples. DNA analysis confirmed 14 isolates were N. risticii and 2 were N. findlayensis, a novel species of Neorickettsia recently demonstrated to cause PHF.

Alzheimer’s disease and related dementias(ADRD) affects 10.3% of older Americans (65+), among these 15-30% go on to be diagnosed with cancer. The highest burden of ADRD is experienced by Latino/a (12.2%) and African-American (13.8%) older adults. Older patients with pre-existing ADRD are less likely to receive guideline-concordant cancer care due to lack of consideration of cognitive status, and underestimation of ADRD diagnosis is an issue in secondary data. Our study compares two validated algorithms for classifying ADRD in a sample of cancer patients, the NCI-Charlson and CMS-Chronic Conditions Warehouse (CCW) index. We used existing claims from NCI’s SEER-Medicare linked database (2004-2013, N=37,932). Patients were selected based on cancer diagnosis at any stage with at least 36 months of data prior to diagnosis to identify ADRD. We analyzed breast, lung, prostate, cervix, head & neck(HNC), and colorectal(CRC) cancers(CA). We found a prevalence of 2.8% (9549 cases of ADRD+CA) using the NCI-index compared with a prevalence of 5.6% (18989 cases) with the CCW-index. ADRD+CA numbers differed significantly in all cancers for all races, however, we observed the greatest magnitude of difference among Latino/a and African-American patients. The NCI index significantly underestimated prevalence compared with the CCW: 1.21% vs 3.28% Breast; 2.29% vs 4.60% CRC; 2.88% vs 6.44% Lung; 1.36% vs 8.62% Prostate, and 4.21% vs 11.61% HNC. Our findings suggest a need to develop validated algorithms for classification, using an evidence-base generated by incorporating information and decision-making theories from the expertise of clinicians currently diagnosing ADRD using clinical assessments in diverse populations.

Infectious respiratory disease is a common cause of morbidity among racehorses. Quantification of contact patterns in training facilities could help inform disease prevention strategies. The study objectives were to: i) describe the contact network among horses, locations, and humans at a Standardbred horse training facility in Ontario; ii) describe the characteristics of highly influential individuals; and iii) investigate how management changes alter the network metrics and discuss the potential implications for disease transmission. Proximity loggers detected contacts among horses, staff, and locations (n = 144). Network metrics and node centrality measures were described for a 2-mode and horse-only contact network. The 2-mode network density was 0.16. and the median node degree was 20 [interquartile range (IQR) = 12 to 27]. Yearlings and floating staff were most influential in the network suggesting biosecurity programs should emphasize reducing contacts in these groups. Removing highly influential staff or co-housing of age groups resulted in changes to network diameter and density.

This report documents the program "Keeping it ReAL (Research in Academic Libraries) 2018: Add it Up" that was held at the University of Victoria on October 26, 2018. This event is the third annual iteration of Keeping it ReAL, a free workshop with the aim of fostering a research culture and creating an open and supportive network for learning, sharing and supporting research among academic librarians in BC. The program focused on the middle stages of the research process, in an effort to enhance academic librarians' skills in gathering, managing, and analyzing research data. The event featured keynote speakers Baharak Yousefi and Shirley Lew, lightning talks on research projects by LIS practitioners, workshops on LIS theory and methodology, and a panel on indigenous research methods. Feedback on the workshop was positive; librarians found the structure of the day effective and appreciated the networking aspect of the event. The report outlines recommendations for continued funding, plans for future programs, and distribution.

As the Liaison Program continues to evolve in response to Library and University priorities, this brief survey is intended to: - Identify and assess the strengths and challenges of the liaison program model; - Elicit ways in which liaison librarians would like support in their roles; - Determine the degree to which the liaison model and current liaison activities meet the emerging needs of the Library. This 30 question survey was distributed online using SurveyMonkey to SFU liaison librarians (departmental and functional) in May 2018. Not all questions were mandatory, and librarians were told that their responses would remain anonymous. We received a total of 27 responses to the survey.

We explored the effect of older partner's age and age difference between partners on condomless sex among men who have sex with men (MSM). We analyzed dyads (n=1720) from participants (n=969) in the Sexual Acquisition Transmission of HIV Cooperative Agreement Program. We used modified Poisson regression to model the probability of a sexual encounter's being condomless as a function of older partner's age and age difference between partners adjusting for HIV status, substance use, race/ethnicity, and partner type. We found an interaction between older partner's age and age difference (p&nbsp

Selected aspects of the transitivity-concordance analysis (DOCX 4499Â kb)

Normative (NF) and personalized feedback (PF) are moderately effective brief interventions for at-risk drinking middle-aged and older adults. This study tested the feasibility of online feedback for drinkers 50 and older. This study's aims were to identify whether there is differential effectiveness of PF over NF in prompting drinkers 50years old and older to plan for change and to determine potential preferences for intervention among adult drinkers 50 and older with practical knowledge about computers.MethodUsing Amazon's Mechanical Turk, 138 male and female drinkers aged 50 to 75+ were recruited to complete an online survey that asked about their: perceptions of their drinking, quantity and frequency of drinking, and any comorbid health and/or mental health disorders/medications. They were then provided either NF or PF. NF provided information about how participants' drinking compared to their same age and gendered peers. PF provided information about level of risk to health and provided recommendations for safe levels of drinking. After feedback, participants were evaluated for their reactions (e.g., "How much does this worry you?") and their plan to change their drinking. Participants were asked about preferences for interventions.Results80% of participants rated themselves a no or low-risk drinker, yet 52.2% were found to be at-risk drinkers. Overall, participants reported feedback was helpful, and 43.9% made some kind of plan to change. Participants in NF were significantly more likely to make a plan for change than those in PF. Participants reported that they most preferred an online (40.9%) or a brief in-person (31.8%) intervention.ConclusionFindings revealed that brief online feedback was feasible, though limited to those who are computer knowledgeable. Unexpectedly, NF outperformed PF, suggesting that peer comparisons may be more motivating for adults 50 and older than previously thought. Finally, an online intervention appears to be a preferred intervention for alcohol use among this particular group of drinkers.

As the SFU Library Liaison Program continues to evolve in response to Library and University priorities, this brief survey is one element in a multi-faceted, continual evaluation process that intends to provide a snapshot of the overall program from the liaison librarians' perspective, as well as to identify 1)areas of success, 2) issues that require further investigation, and 3) new areas of growth emerging in the work.This 23 question survey was distributed online using FluidSurveys to SFU liaison librarians (departmental and functional) in May 2017. Not all questions were mandatory, and librarians were told that their responses would remain anonymous. We received a total of 24 responses to the survey, 21 of which were complete.

The Coalition of Open Access Policy Institutions (COAPI, https://sparcopen.org/coapi ) is committed to sharing information and resources to assist in the development and implementation of institutional Open Access (OA) policies. The COAPI Toolkit includes a diverse collection of resources that COAPI members have developed in the course of their OA policy initiatives. These resources are openly accessible and published here under Creative Commons Attribution 4.0 licenses, unless otherwise noted on the resources themselves.

In 2015, McGill University Library undertook a project to investigate, propose, and pilot test a method for evaluating the quality and outcomes of reference consultations. The goal of the project was to gather evidence to demonstrate the importance of reference consultations as part of librarians’ core contributions to the university. The evaluation tool was developed based on input from librarians, users, and a review of the literature. The evaluation was sent out to 98 users during the pilot test period. There were 53 responses to the evaluation tool for a response rate of 54%. Though preliminary, the results of the pilot test can be helpful in determining the usefulness of evaluating reference consultations, and the outcomes of engaging in assessment of this core library service. The results from this project suggest that implementing a tool to evaluate consultations can be used to inform services and to demonstrate the value of the library for research, teaching, and learning.

This study developed and then tested the feasibility, acceptability and initial efficacy of a 3-session, culturally adapted, intervention combining motivational enhancement therapy (MET) and strengths-based case management (SBCM) delivered by promotoras in Spanish to reduce heavy drinking among male, Latino day laborers. A pilot two-group randomized trial (N=29) was conducted to evaluate the initial efficacy of MET/SBCM compared to brief feedback (BF). Alcohol-related measures were assessed at 6, 12 and 18weeks after baseline. Most intervention group participants (12/14) attended all counseling sessions and most participants (25/29) remained in the study at 18weeks. Alcohol related measures improved in both groups over time with no statistically significant differences observed at any of the time points. However the comparative effect size of MET/SBCM on weekly drinking was in the large range at 6-weeks and in the moderate range at 12-weeks. Post hoc analyses identified a statistically significant reduction in number of drinks over time for participants in the intervention group but not for control group participants. Despite the extreme vulnerability of the population, most participants completed all sessions of MET/SBCM and reported high satisfaction with the intervention. We feel our community partnership facilitated these successes. Additional studies of community-partnered and culturally adapted interventions are needed to reduce heavy drinking among the growing population of Latinos in the U.S.

ObjectiveThis aim of this study was to characterize trends in alcohol-related hospital admissions among middle-aged and older adults from 1993 to 2010 in relation to age, gender, race, and cohort membership.MethodThis study utilized repeated cross-sectional data from the Nationwide Inpatient Sample. Using alcohol-related classified admissions, yearly rates and longitudinal trends of alcohol-related inpatient hospitalizations based on age, period, birth cohort, gender, and race were estimated.ResultsAmong those aged 45 and older, admissions rose from an estimated 610,634 to more than 1,134,876, and rates of any alcohol-related diagnosis also increased from 1993 to 2010. Rates for men were consistently higher than women, and rates for Blacks were higher than Whites. Age was associated with decreasing rates, but post-World War II cohorts displayed higher rates over time.DiscussionRates of alcohol-related admissions are increasing among adults above age 45, which may be a function of cohort effects. Training the health care workforce is crucial to respond to this trend.

Objectives To compare 12-month outpatient healthcare expenditures of at-risk and not-at-risk drinkers aged 60 and older. Design Secondary analysis of data from Project Senior Health and Alcohol Risk Education, a cluster, randomized trial to test the efficacy of an intervention to reduce at-risk drinking. Setting Seven primary care clinics in or near Santa Barbara, California. Participants Current drinkers aged 60 and older who completed a baseline survey (N = 2,779) and did not receive the study intervention, including 628 at-risk drinkers and 2,151 not-at-risk drinkers. Measurements Comparisons of at-risk and not-at-risk drinkers for baseline demographic characteristics, health indicators, alcohol consumption, and adjusted and unadjusted outpatient healthcare expenditures incurred over 12 months after baseline. Results At-risk drinkers were younger, more often male, and more likely to be married and had higher education and incomes than not-at-risk drinkers. Unadjusted 12-month mean outpatient healthcare expenditures were 1,333 ± 2,973 for at-risk drinkers and 1,417 ± 2,952 for the not-at-risk drinkers. There were no statistically significant differences in expenditures between groups before and after controlling for sociodemographic and health characteristics. Conclusion In this short-term study, no adjusted differences in healthcare expenditures were observed between at-risk and not-at-risk older drinkers. Future study is warranted to determine the role of at-risk drinking in long-term healthcare expenditures in older adults. © 2014, The American Geriatrics Society.

A 13-year-old Percheron gelding was presented for refractory gastric impaction. At necropsy a pedunculated 10 cm × 11 cm × 14 cm mass, histologically identified as an inflammatory polyp, was suspected to have been partly obstructing the pylorus. This is the first report of a polyp resulting in gastric outflow obstruction in a horse.

In one Los Angeles study, 20 % of day laborers reported excessive drinking. Older adults are more sensitive to alcohol's effects, yet heavy drinking persists among Latinos until they are in their 60s. No interventions to reduce heavy drinking exist for aging day laborers. We recruited 14 day laborers aged 50 and older in Los Angeles. We identified their unhealthy alcohol use behaviors and comorbidities and conducted semi-structured interviews to understand their perceptions of unhealthy alcohol use. We found social disadvantages and conditions exacerbated by alcohol use, like depression. Participants were concerned with dying and premature aging, and reported that family could influence behavior change. An intervention should consider (1) integrating family values and (2) increasing knowledge about alcohol use and comorbidities. Further studies are needed to explore family influence on aging Latino day laborers.

Projekt "Inter Community Learning" proveden je u razdoblju od 1. 8.2011. do 31.7.2013. godine. Nositelj projekta je bila Varaždinska županija je s partnerima iz Velike Britanije, općinom Hillingdon, osnovnom školom Yeading Yunior School, sveučilištem Buckinghamshire New University te Osnovnom školom Petrijanec i Fakultetom organizacije i informatike iz Varaždina. Glavni ciljevi projekta bili su: unaprijediti uspješnost i samopouzdanje djece s rizikom slabog uspjeha/neuspjeha tj. djece koja su u riziku od pada školske godine u dobi između 5 i 11 godina u Ujedinjenom Kraljevstvu, te 7-11 godina u Republici Hrvatskoj ; unaprijediti samopouzdanje, postignuće i obrazovne težnje učenika koji sudjeluju u projektu ; stvoriti bolje odnose između škola, zajednica i lokalnih visokoškolskih ustanova ; promovirati volonterizam kao način nezamjenjivog djelovanja u zajednici.

To examine the association between alcohol consumption and mortality among older Mexican American men, with and without pre-existing cardiovascular conditions.We conducted survival analysis among 908 men aged 65-80 years from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE), a longitudinal population-based study of older Mexican Americans who reside in the southwestern United States. Men were categorized into four alcohol-consumption groups: lifetime abstainers, former drinkers, low risk drinkers (or =30 drinks/month andor =3 drinks/occasion) and at-risk drinkers (30 drinks/month or3 drinks/occasion) and stratified into two groups: those with and those without pre-existing cardiovascular conditions. Mortality was ascertained from 1993-1994 to 2007.Among participants without pre-existing cardiovascular conditions, former, low risk, and at-risk drinkers had a lower risk for all-cause mortality compared to lifetime abstainers [HR: .70, 95% CI (.50-.99), .64 (.42-.97) and .60 (.40-.92), respectively]. There was no statistically significant association between mortality and any of the alcohol consumption groups among those with cardiovascular conditions.Among older Mexican-American men without cardiovascular conditions, former and current drinkers had lower mortality compared to abstainers. No such associations were observed between alcohol use and mortality among those with cardiovascular conditions.

"Alison Moore's sparkling collection of essays offers a host of fascinating perspectives on gender in French politics from the European witch-craze through to the current head-scarf controversy." - Colin Jones, Professor of History, Queen Mary University of London "Sexing Political Culture in the History of France gathers together several compelling essays that nuance older studies about how gender and sexual symbols stand in for the nation in its various incarnations from the Early Modern period to the present. By combining a long historical trajectory with detailed analyses of how the state or its opponents have used symbolic meaning to mobilize political action, clarify or criticize hierarchy, or simply make sense of social norms, these essays demonstrate the distinctive power of such symbolism and thus of this area of focus, which traverses intellectual, social, cultural history as well as the history of gender and sexuality. This is a cutting-edge collection that moves coherently from the early modern witch hunt to race in postcolonial France." - Carolyn J. Dean, John Hay Professor of International Studies, Brown University "Sexing Political Culture in the History of France marks a genuinely new departure in European history of sexuality studies. Alison Moore has gathered together contributions which demonstrate the manifold ways in which the language of gendered and sexualized stereotypes, behaviors, and practices has been deployed in the service of patriotic propaganda and the othering energies of nationalism in the French context. Further, she urges a nuanced focus on the fact that scholars too have embraced the tendency to metaphorize national, religious and political situations using sexual and gendered symbols. As such, the book also stands as a meditation on the political and libidinal character of historiography itself. The essays collected together in the volume cover a broad historical span and treat a wide-ranging array of fascinating topics from sixteenth- and seventeenth-century witch-hunts to historically recent debates about French secularism, Islamophobia, and the wearing of the veil. This book is a must-read for all students and scholars of French and European studies, gender and sexuality studies, and the history of ideas." - Lisa Downing, Professor of French Discourses of Sexuality, University of Birmingham

"Alison Moore's sparkling collection of essays offers a host of fascinating perspectives on gender in French politics from the European witch-craze through to the current head-scarf controversy." - Colin Jones, Professor of History, Queen Mary University of London "Sexing Political Culture in the History of France gathers together several compelling essays that nuance older studies about how gender and sexual symbols stand in for the nation in its various incarnations from the Early Modern period to the present. By combining a long historical trajectory with detailed analyses of how the state or its opponents have used symbolic meaning to mobilize political action, clarify or criticize hierarchy, or simply make sense of social norms, these essays demonstrate the distinctive power of such symbolism and thus of this area of focus, which traverses intellectual, social, cultural history as well as the history of gender and sexuality. This is a cutting-edge collection that moves coherently from the early modern witch hunt to race in postcolonial France." - Carolyn J. Dean, John Hay Professor of International Studies, Brown University "Sexing Political Culture in the History of France marks a genuinely new departure in European history of sexuality studies. Alison Moore has gathered together contributions which demonstrate the manifold ways in which the language of gendered and sexualized stereotypes, behaviors, and practices has been deployed in the service of patriotic propaganda and the othering energies of nationalism in the French context. Further, she urges a nuanced focus on the fact that scholars too have embraced the tendency to metaphorize national, religious and political situations using sexual and gendered symbols. As such, the book also stands as a meditation on the political and libidinal character of historiography itself. The essays collected together in the volume cover a broad historical span and treat a wide-ranging array of fascinating topics from sixteenth- and seventeenth-century witch-hunts to historically recent debates about French secularism, Islamophobia, and the wearing of the veil. This book is a must-read for all students and scholars of French and European studies, gender and sexuality studies, and the history of ideas." - Lisa Downing, Professor of French Discourses of Sexuality, University of Birmingham

"Alison Moore's sparkling collection of essays offers a host of fascinating perspectives on gender in French politics from the European witch-craze through to the current head-scarf controversy." - Colin Jones, Professor of History, Queen Mary University of London "Sexing Political Culture in the History of France gathers together several compelling essays that nuance older studies about how gender and sexual symbols stand in for the nation in its various incarnations from the Early Modern period to the present. By combining a long historical trajectory with detailed analyses of how the state or its opponents have used symbolic meaning to mobilize political action, clarify or criticize hierarchy, or simply make sense of social norms, these essays demonstrate the distinctive power of such symbolism and thus of this area of focus, which traverses intellectual, social, cultural history as well as the history of gender and sexuality. This is a cutting-edge collection that moves coherently from the early modern witch hunt to race in postcolonial France." - Carolyn J. Dean, John Hay Professor of International Studies, Brown University "Sexing Political Culture in the History of France marks a genuinely new departure in European history of sexuality studies. Alison Moore has gathered together contributions which demonstrate the manifold ways in which the language of gendered and sexualized stereotypes, behaviors, and practices has been deployed in the service of patriotic propaganda and the othering energies of nationalism in the French context. Further, she urges a nuanced focus on the fact that scholars too have embraced the tendency to metaphorize national, religious and political situations using sexual and gendered symbols. As such, the book also stands as a meditation on the political and libidinal character of historiography itself. The essays collected together in the volume cover a broad historical span and treat a wide-ranging array of fascinating topics from sixteenth- and seventeenth-century witch-hunts to historically recent debates about French secularism, Islamophobia, and the wearing of the veil. This book is a must-read for all students and scholars of French and European studies, gender and sexuality studies, and the history of ideas." - Lisa Downing, Professor of French Discourses of Sexuality, University of Birmingham

To identify predictors of alcohol-related patient-physician discussions.Cross-sectional study using baseline data from a randomized controlled trial.Community-based group practice.Thirty-one physicians in Project Senior Health and Alcohol Risk Education and 3,305 of their patients aged 60 and older who use alcohol and completed a survey that included the Comorbidity Alcohol Risk Evaluation Tool (CARET).At study baseline, older adults were asked whether alcohol-related discussions with a physician had occurred in the prior year. This outcome was modeled using logistic regression models with physician random effects. Predictor variables included patient-level variables such as demographics and seven CARET-defined risk factors, specifically a medical or psychiatric comorbidity that alcohol might worsen, a potentially alcohol-related symptom, use of a medication that may interact negatively with alcohol, excessive quantity or frequency of alcohol use, binge drinking, concern from others about drinking, and drinking and driving. Physician-level predictors (age, sex, years since graduation, specialty) were also included.The probability of reporting alcohol-related discussions declined with patient age (e.g., odds ratio (OR)=0.40 for patients aged ≥80) and was significantly lower for Latinos (OR=0.38). Drinking and driving (OR=1.69) or concern from others (OR=6.04) were significantly associated with alcohol-related discussions; having comorbidities or using medications that may interact with alcohol were not.Although patient demographics, including age and ethnicity, are associated with the occurrence of alcohol-related discussions, clinical factors that may negatively interact with alcohol to increase risk are not. This suggests that physicians may not be attuned to the entire spectrum of alcohol-related risks for older adults.

To describe differences between older at-risk drinkers, as determined using the Comorbidity Alcohol Risk Evaluation Tool, who reduced drinking and those who did not after an initial intervention and to determine factors associated with early reductions in drinking.Secondary analyses of data from a randomized controlled trial.Seven primary care sites.Subjects randomized to the intervention group who completed the first health educator call approximately 2 weeks after enrollment (n=239).Personalized risk reports, booklets on alcohol-associated risks, and advice from physicians, followed by a health educator call.Reductions in number of alcoholic drinks.Thirty-nine percent of the sample had reduced drinking within 2 weeks of receiving the initial intervention. According to the final multiple logistic regression model, those who were concerned about alcohol-related risks (odds ratio (OR)=2.03, 95% confidence interval (CI)=1.01-4.07), read through the educational booklet (OR=2.97, 95% CI=1.48-5.95), or perceived that their physicians discussed risks and advised changing drinking behaviors (OR=4.1, 95% CI=2.02-8.32) had greater odds of reducing drinking by the first health educator call.Concern about risks, reading educational material, and perception of physicians providing advice to reduce drinking were associated with early reductions in alcohol use in older at-risk drinkers. Understanding these factors will enable development of better intervention strategies to reduce unhealthy alcohol use.

To examine the combined influence of alcohol use and comorbidity on 20-year mortality in older adults (average age 66 at the time of the baseline survey). DESIGN: Longitudinal analysis of a national probability sample-based cohort study. SETTING: Data sources were the National Health and Nutrition Examination Survey I (NHANES I), 1971-1974, and the NHANES Epidemiologic Followup Survey, 1992. PARTICIPANTS: Four thousand six hundred ninety-one adults aged 60 and older who provided data on alcohol use. MEASUREMENTS: The prevalence of at-risk drinking in older adults in the United States and the 20-year all-cause mortality risk associated with it. At-risk drinking status was determined from amount of alcohol consumed and comorbidities, using a previously validated method. RESULTS: The prevalence of at-risk drinking in the United States between 1971 and 1974 in older adults was 10% (18% of men, 5% of women). The majority of at-risk drinkers were identified as such because of their use of alcohol in amounts deemed risky in the presence of relevant comorbidities (69%) (e.g., drinking 2-3 drinks per day and having gout or anxiety or taking a medication for pain). In men, at-risk drinking was associated with higher mortality rates than not-at-risk drinking (hazard ratio=1.20, 95% confidence interval=1.01-1.41); abstinence was not associated with greater mortality. In women, neither abstinence nor at-risk drinking was associated with greater mortality rates. CONCLUSION: In this first, large population-based study of older adults examining the mortality risks of alcohol use and comorbidity, at-risk drinking was associated with greater mortality rates in men. These findings suggest that a lower threshold of alcohol use should be recommended for older adults with specific comorbidities to reduce mortality risks.

Second semester University: Université de Strasbourg.

The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults. Six focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes. Most participants (96%) employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain. Providers perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods, and implementing provider and patient educational interventions could help to improve the management of chronic pain in later life.

Since the 1990s there has been a burgeoning focus on the experience and treatment of children in the ancient world. The majority of studies have utilized historical and iconographic sources more than the archaeological record, resulting in an image of Roman childhood that is dominated by the view from Rome. For Roman Britain, the archaeological context, especially the funerary domain, is a fruitful source of evidence concerning childhood. The bioarchaeological and material evidence from Romano-British cemeteries is reviewed here. Skeletal remains provide valuable evidence relating to the health and care of past children. The integration of the skeletal data with the material evidence from the funerary context can illuminate past perceptions of childhood and the social construction of this earlier part of the life course. Theoretical and methodological developments within archaeology are paving the way for a more complete understanding of Roman childhood.

This chapter provides a summary of changing interpretation of Roman Britain between 1586 and 1906. It commences with the interpretation of the history of the Roman province outlined by William Camden in his seminal account Britannia. It provides an exploration of two myths of origin that had a powerful role in England in the centuries following Camden: the idea that civilization in the lowlands commenced with the Roman Conquest and the contrasting idea that the Roman population of Britain were incomers from Italy and the Mediterranean. The chapter provides a summary of the way that the increasing knowledge of pre-Roman and Roman Britain was drawn upon by Francis Haverfield to produce his account of the Romanization of Roman Britain (1906). This influential idea of the civilizing of lowland Britons in Roman times created a tradition of archaeological research that dominated much of the twentieth century.

Androgens play a key role in skeletal growth and bone maintenance; however, their mechanism of action remains unclear. To address this, we selectively deleted the androgen receptor (AR) in terminally differentiated, mineralizing osteoblasts using the Cre/loxP system in mice (osteocalcin-Cre AR knockouts [mOBL-ARKOs]). Male mOBL-ARKOs had decreased femoral trabecular bone volume compared with littermate controls because of a reduction in trabecular number at 6, 12, and 24 wk of age, indicative of increased bone resorption. The effects of AR inactivation in mineralizing osteoblasts was most marked in the young mutant mice at 6 wk of age when rates of bone turnover are high, with a 35% reduction in trabecular bone volume, decreased cortical thickness, and abnormalities in the mineralization of bone matrix, characterized by increased unmineralized bone matrix and a decrease in the amount of mineralizing surface. This impairment in bone architecture in the mOBL-ARKOs persisted throughout adulthood despite an unexpected compensatory increase in osteoblast activity. Our findings show that androgens act through the AR in mineralizing osteoblasts to maintain bone by regulating bone resorption and the coordination of bone matrix synthesis and mineralization, and that this action is most important during times of bone accrual and high rates of bone remodeling. Refereed/Peer-reviewed

Clinical studies indicate that the combination of vitamin D and dietary calcium supplementation is more effective for reducing fracture risk than either supplement alone. Our previous dietary studies demonstrated that an adequate serum 25-hydroxyvitamin D3 (25D) of 80nmol/L or more reduces bone RANKL expression, osteoclastogenesis and maintains the optimal levels of trabecular bone volume (BV/TV%) in young rats. The important clinical question of the interaction between vitamin D status, dietary calcium intake and age remains unclear. Hence, 9 month-old female Sprague-Dawley rats (n=5-6/group) were pair-fed a semi-synthetic diet containing varying levels of vitamin D (0, 2, 12 or 20IU/day) and dietary calcium (0.1% or 1%) for 6 months. At 15 months of age, animals were killed, for biochemical and skeletal analyses. While changes to serum 25D were determined by both dietary vitamin D and calcium levels, changes to serum 1,25-dihydroxyvitamin D3 (1,25D) were consistently raised in animals fed 0.1% Ca regardless of dietary vitamin D or vitamin D status. Importantly, serum cross-laps levels were significantly increased in animals fed 0.1% Ca only when combined with 0 or 2 IUD/day of vitamin D, suggesting a contribution of both dietary calcium and vitamin D in determining bone resorption activity. Serum 25(OH)D3 levels were positively correlated with both femoral mid-diaphyseal cortical bone volume (R(2)=0.24, P

We report studies that suggest enzyme replacement therapy will result in a significant reduction in disease progression and tissue pathology in patients with Maroteaux-Lamy syndrome (Mucopolysaccharidosis type VI, MPS VI). A feline model for MPS VI was used to evaluate tissue distribution and clinical efficacy of three forms of recombinant human N-acetylgalactosamine-4-sulfatase (rh4S, EC 3.1.6.1). Intravenously administered rh4S was rapidly cleared from circulation. The majority of rh4S was distributed to liver, but was also detected in most other tissues. Tissue half-life was approximately 2-4 d. Three MPS VI cats given regular intravenous infusions of rh4S for up to 20 mo showed variable reduction of storage vacuoles in Kupffer cells and connective tissues, however cartilage chondrocytes remained vacuolated. Vertebral bone mineral volume was improved in two MPS VI cats in which therapy was initiated before skeletal maturity, and increased bone volume appeared to correlate with earlier age of onset of therapy. One cat showed greater mobility in response to therapy.

Despite the therapeutic value of calcitonin in treating bone disease, a biological role of endogenous calcitonin is controversial. Having previously demonstrated that the CTR has a biological role in protecting against calcium stress using a global CTRKO mouse model, the purpose of this study was to determine whether the protection conferred by the CTR during induced hypercalcemia is mediated via CTR expression on osteoclasts. Mice were generated, in which the CTR was deleted specifically within osteoclasts (OCL-CTRKOs) and compared with mice in which the CTR was deleted globally (global CTRKOs). Significantly, peak serum calcium levels following induced hypercalcemia were N18% higher in global-CTRKOs and OCL-CTRKOs than controls (Pb0.01) due to increased bone resorption (Pb0.05). Peak serum calcium levels relative to controls were greater in global-CTRKO males than OCL-CTRKO males (Pb0.001), which may, at least in part, be due to increased reabsorption of calcium in the kidney (Pb0.01). Controls for all analyses were sex-matched littermates with normal CTR expression. In conclusion, the CTR protects against hypercalcemia predominantly via its inhibitory action on osteoclasts. Refereed/Peer-reviewed

We used our genomic androgen receptor (AR) knockout (ARKO) mouse model, in which the AR is unable to bind DNA to: 1) document gender differences between males and females; 2) identify the genomic (DNA-binding-dependent) AR-mediated actions in males; 3) determine the contribution of genomic AR-mediated actions to these gender differences; and 4) identify physiological genomic AR-mediated actions in females. At 9 weeks of age, control males had higher body, heart and kidney mass, lower spleen mass, and longer and larger bones compared to control females. Compared to control males, ARKO males had lower body and kidney mass, higher splenic mass, and reductions in cortical and trabecular bone. Deletion of the AR in ARKO males abolished the gender differences in heart and cortical bone. Compared with control females, ARKO females had normal body weight, but 14% lower heart mass and heart weight/body weight ratio. Relative kidney mass was also reduced, and relative spleen mass was increased. ARKO females had a significant reduction in cortical bone growth and changes in trabecular architecture, although with no net change in trabecular bone volume. In conclusion, we have shown that androgens acting via the genomic AR signaling pathway mediate, at least in part, the gender differences in body mass, heart, kidney, spleen, and bone, and play a physiological role in the regulation of cardiac, kidney and splenic size, cortical bone growth, and trabecular bone architecture in females.

We have previously shown that vitamin D deficiency in young male rats results in significant reduction in femoral trabecular bone volume (BV/TV). However, the effects of vitamin D deficiency and its impact on other relevant skeletal sites remain unclear. Ten week old male Sprague-Dawley rats were fed various levels of vitamin D3 (2, 4, 8, and 12 IU/day) with standard Ca (0.4%) until 30 weeks of age and achieved stable serum 25-hydroxyvitamin D3 (25D) levels between 16 and 117 nmol/L. At time of death, femora, L2 vertebrae and tibiae were processed for bone histomorphometric analyses and tibial cortical strength by 3-point mechanical testing. A significant association between serum 25D and trabecular bone occurred for both the distal femoral metaphysis (R2 = 0.34, P < 0.05) and L2 vertebrae (R2 = 0.24, P < 0.05). Tibia mid-shaft cortical bone was not, however, changed in terms of total volume, periosteal surface or endosteal surface as a function of vitamin D status. Furthermore, no changes to mechanical and intrinsic properties of the cortices were observed. We conclude that cortical bone is maintained under conditions of vitamin D deficiency in preference to cancellous bone in young growing rats. Refereed/Peer-reviewed