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BACKGROUND: Older people are often explicitly or implicitly excluded from research, in particular clinical trials. This means that study findings may not be applicable to them, or that older people may not be offered treatments due to an absence of evidence. AIMS: The aim of this work was to develop recommendations to guide all research relevant to older people. METHODS: A diverse stakeholder group identified barriers and solutions to including older people in research. In parallel, a rapid literature review of published papers was undertaken to identify existing papers on the inclusion of older people in research. The findings were synthesised and mapped onto a socio-ecological model. From the synthesis we identified themes that were developed into initial recommendations that were iteratively refined with the stakeholder group. RESULTS: A range of individual, interpersonal, organisational, community and policy factors impact on the inclusion of older people in research. A total of 14 recommendations were developed such as removing upper age limits and comorbidity exclusions, involving older people, advocates and health and social care professionals with expertise in ageing in designing the research, and considering flexible or alternative approaches to data collection to maximise opportunities for participation. We also developed four questions that may guide those developing, reviewing and funding research that is inclusive of older people. CONCLUSION: Our recommendations provide up to date, practical advice on ways to improve the inclusion of older people in health and care research.

Background Data on respiratory syncytial virus (RSV) disease burden in adults remain scarce. We assessed the burden of confirmed RSV-acute respiratory infections (cRSV-ARIs) in community-dwelling (CD) adults and those in long-term care facilities (LTCFs). Methods In this prospective cohort study covering 2 RSV seasons (October 2019–March 2020 and October 2020–June 2021), RSV-ARIs were identified through active surveillance, in medically stable CD-adults ≥50 years (Europe) or adults ≥65 years in LTCFs (Europe and the United States). RSV infection was confirmed by polymerase chain reaction from combined nasal and throat swabs. Results Of 1981 adults enrolled, 1251 adults in CD and 664 LTCFs (season 1) and 1223 adults in CD and 494 LTCFs (season 2) were included in the analyses. During season 1, overall incidence rates ([IRs] cases/1000 person-years) and attack rates (ARs) for cRSV-ARIs were 37.25 (95% confidence interval [CI], 22.62–61.35) and 1.84% in adults in CD and 47.85 (CI, 22.58–101.4) and 2.26% in adults in LTCFs. Complications occurred for 17.4% (CD) and 13.3% (LTCFs) of cRSV-ARIs. One cRSV-ARI occurred in season 2 (IR = 2.91 [CI, 0.40–20.97]; AR = 0.20%), without complications. No cRSV-ARIs led to hospitalization or death. Viral pathogens were codetected in ≤17.4% of cRSV-ARIs. Conclusions RSV is an important cause of disease burden in adults in CD and LTCFs. Despite the observed low severity of cRSV-ARI, our results support the need for RSV prevention strategies among adults ≥50 years old.

BackgroundThere has been limited evaluation of health-related quality of life (HRQOL) in rectal cancer patients receiving neoadjuvant chemoradiotherapy. HRQOL outcomes in the National Surgical Adjuvant Breast and Bowel Project R-04 trial are examined in this article.MethodsBetween 2004 and 2010, R-04 patients were invited to enroll in the HRQOL substudy, with questionnaires administered before randomization, after completion of chemoradiotherapy, and 1-year after surgery. HRQOL measures included: Functional Assessment of Cancer Therapy for colorectal cancer (FACT-C); Short Form-36v.2 Vitality scale; a treatment-specific symptom scale; and the FACT neurotoxicity scale. A 5-year postsurgery assessment was added to the protocol in 2012. Mixed-effects models examined neoadjuvant therapy treatment effects in the 1-year sample and models that explored associations of host factors and treatment impact on 5-year HRQOL.ResultsA total of 1373 patients completed baseline HRQOL and at least one additional assessment. The average age was 58 years (range, 23-85 years), male (68%), and 59% Stage II. There were no statistically significant differences in HRQOL outcomes by treatment arm, but HRQOL worsened from baseline to postneoadjuvant chemoradiotherapy, with statistically significant effect sizes changes ranging from 0.6 (Vitality) to 0.9 (FACT-C Trial Outcome Index). Neurotoxicity was greater in the oxaliplatin-treated groups. Obese/overweight patients had statistically significantly worse FACT-C Trial Outcome Index scores than did underweight/normal weight groups. At 5 years, younger patients and those with normal baseline weight had statistically significantly better physical function scores and older patients had better mental health outcomes.ConclusionsHRQOL did not differ across the four R-04 treatment arms; however, host factors explained significant variation in posttreatment HRQOL.Clinicaltrialsgov: NCT00058474 (https://ClinicalTrials.gov/ct2/show/NCT00058474).Lay summaryThis article reports on the health-related quality of life (HRQOL) outcomes of patients treated with four different chemotherapy regimens combined with radiation in rectal cancer patients before definitive surgical treatment. There were no significant differences in HRQOL by treatment regimen, but all patients experienced decreased vitality (energy) and physical functioning. By 1 year after treatment, most patients had returned to pretreatment vitality and physical functioning, with the exception of increased neurotoxicity. In a subsample of patients assessed at 5 years after surgery, physical function was better in those who at pretreatment were younger, normal weight, and had better performance status. Mental function was better in those who at pretreatment were older and had better performance status.

Inflammation and dysregulated immunity are important in the development of pulmonary arterial hypertension. Compelling preclinical data supports the therapeutic blockade of interleukin-6 signalling.We conducted an open-label phase-II study of intravenous tocilizumab (8 mg·kg-1) over 6 months in group 1 pulmonary arterial hypertension. Co-primary endpoints were safety, defined by incidence and severity of adverse events, and change in pulmonary vascular resistance. Separately, a Mendelian randomisation study was undertaken on 11,744 individuals with European ancestry including 2085 patients with idiopathic/heritable disease for the IL6R variant (rs7529229), known to associate with circulating IL6R levels.Twenty-nine patients (M/F 10/19; mean age 54.9[SD11.4]) were recruited. Nineteen had heritable/idiopathic and ten connective tissue disease associated pulmonary arterial hypertension. Six were withdrawn prior to drug administration. Twenty-three patients received at least one dose of tocilizumab. Tocilizumab was discontinued in 4 patients due to serious adverse events. There were no deaths. Despite evidence of target engagement in plasma interleukin-6 and C-reactive protein levels, both intention-to-treat and modified intention-to-treat analyses demonstrated no change in pulmonary vascular resistance. Inflammatory markers did not predict treatment response. Mendelian randomisation did not support an effect of the lead IL6R variant on risk of pulmonary arterial hypertension (OR 0.99, p=0.88).Adverse events were consistent with the known safety profile of tocilizumab. Tocilizumab did not show any consistent treatment effect.

Cashew (Anacardium occidentale) tree is mainly known for the production of cashew nuts. Cashew apple also known as pseudo-fruit is the by-product of cashew nut production. The fruit is often neglected due to its high perishability. It is important to note that cashew nut production leads to average wastage of around 2 million tons in Maharashtra alone. Additionally, cashew apple needs to be known for its value-added potential as it is a rich source of ascorbic acid, polyphenols, minerals, vitamins and sugars. Recovery of these high-value nutrients may render the cashew apple processing sustainable and will further add value to the fruit waste. The authors herein review the sustainable application and benefit of cashew apple as a byproduct of cashew nut production.

Supplemental material, sj-docx-1-pie-10.1177_09544089221096052 for Experimental studies on natural bank type heating/cooling energy saving Air conditioning system by Vaishali Goyal, Arun Kumar Asati, Rajeev Kumar Garg and Amit Arora in Proceedings of the Institution of Mechanical Engineers, Part E: Journal of Process Mechanical Engineering

Additional file 3. PICO framework.

Additional file 6. PRISMA checklist.

Additional file 1. Previous systematic review summary.

Additional file 7. Quality assessment of included studies.

Supplemental material, sj-docx-1-pie-10.1177_09544089221096052 for Experimental studies on natural bank type heating/cooling energy saving Air conditioning system by Vaishali Goyal, Arun Kumar Asati, Rajeev Kumar Garg and Amit Arora in Proceedings of the Institution of Mechanical Engineers, Part E: Journal of Process Mechanical Engineering

Additional file 4. Search strategy.

Additional file 2. Eligibility criteria.

Additional file 5. Reasons for exclusion of studies.

My talk will touch upon the United Nations Sustainable Development Goals. I will provide an overview of GIS applications in accomplishing one or more of these goals.

Additional file 3. Reasons for exclusion of studies.

Additional file 4: Appendix 4. Reasons for exclusion of studies

Additional file 1: Table S1. List of dietary items (n = 32) recorded in the Short Food Frequency Questionnaire.

Additional file 4. JBI Critical Appraisal Checklist for Randomised Control Trials.

Additional file 3: Appendix 3. MEDLINE search strategy

Additional file 1: Appendix 1. Prisma Checklist

Additional file 1. PRISMA checklist.

Additional file 2. Search Strategy (Embase OVID).

Additional file 1. Food security survey among Libyan migrant families in Australia. Questionnaire including sociodemographic, socioeconomic and food security questions.

Additional file 2. Graphs depicting the individual trajectories of seven mutually exclusive food groups.

Additional file 5. JBI Checklist for Quasi-Experimental Studies.

Additional file 2: Appendix 2. PICOS (Search terms)

Additional file 1: SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents*

Additional file 2. Percentage point change in the prevalence of underweight by study factors, 2000–2016. n (%): weighted count and proportion for each variable. *Diff indicates the point percentage change in prevalence of underweight between 2000 to 2016.

Additional file 1: SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents*

Additional file 3. Percentage point change in the prevalence of overweight/obesity by study factors, 2000–2016. n (%): weighted count and proportion for each variable. *Diff indicates the point percentage change in prevalence of underweight between 2000 to 2016.

Additional file 4: Appendix 4. List of excluded studies and reasons for exclusion.

Additional file 5: Appendix 5. Assessment of risk of bias in included studies – full table.

Additional file 1. Telephone interview guide for GPs.

Additional file 2: Appendix 2. Search Strategy example using the MEDLINE database.

Additional file 1. Characteristics of urban women in Ethiopia, 2000–2016. n (%): weighted count and proportions for each variable. *SNNPR: Southern Nations Nationalities and Peoples Region.

Additional file 2: Participant survey

Additional file 6: Appendix 6. Raw data extracted for meta-analyses of exclusive breastfeeding to 1, 3, and 6 months.

Additional file 4. Bar graphs showing trends of underweight and overweight/obesity by each study variables from 2000 to 2016.

Additional file 6: Appendix 6. Raw data extracted for meta-analyses of exclusive breastfeeding to 1, 3, and 6 months.

Additional file 2. Consolidated criteria for reporting qualitative studies (COREQ): 32-item checklist.

Additional file 1: Appendix 1. PRISMA Checklist.

Additional file 4: Appendix 4. List of excluded studies and reasons for exclusion.

Additional file 2: Participant survey

Additional file 5: Appendix 5. Assessment of risk of bias in included studies – full table.

Background. At high altitude changes in corneal thickness and intraocular pressure (IOP) has been a subject of investigation for decades. The mechanism of action of these changes is still unknown. Extensive research is carried out to know effect of hypoxia on humans at high altitude. Corneal thickness and intraocular pressure are important parameter in ophthalmology with both diagnostic and therapeutic implications. We studied the corneal thickness and intraocular pressure in highlanders and compared the same with lowlanders. Methods. This observational study included two groups, each consisting of 500 individuals residing at high altitude (more than 10,000 ft above sea level). Three measurements of intraocular pressure of both eyes in each group were noted with Goldmann applanation tonometer and mean of the three readings was taken. Central Corneal Thickness (CCT) was measured by ultra sound pachymetry. The parameters of two groups were compared statistically. Results. There was a statistically significant difference between corneal thicknesses of the two groups studied, however no overall statistically significant difference in intraocular pressure of both these groups was found. Conclusion. The highlanders have a thinner cornea as compared to lowlanders. The IOP is significantly higher in the highlander males as compared to lowlander males. However, the mean IOP is comparable between the overall population of the high altitude and that of low altitude.

BackgroundRare genetic variants cause pulmonary arterial hypertension, but the contribution of common genetic variation to disease risk and natural history is poorly characterised. We tested for genome-wide association for pulmonary arterial hypertension in large international cohorts and assessed the contribution of associated regions to outcomes.MethodsWe did two separate genome-wide association studies (GWAS) and a meta-analysis of pulmonary arterial hypertension. These GWAS used data from four international case-control studies across 11 744 individuals with European ancestry (including 2085 patients). One GWAS used genotypes from 5895 whole-genome sequences and the other GWAS used genotyping array data from an additional 5849 individuals. Cross-validation of loci reaching genome-wide significance was sought by meta-analysis. Conditional analysis corrected for the most significant variants at each locus was used to resolve signals for multiple associations. We functionally annotated associated variants and tested associations with duration of survival. All-cause mortality was the primary endpoint in survival analyses.FindingsA locus near SOX17 (rs10103692, odds ratio 1·80 [95% CI 1·55-2·08], p=5·13 × 10-15) and a second locus in HLA-DPA1 and HLA-DPB1 (collectively referred to as HLA-DPA1/DPB1 here; rs2856830, 1·56 [1·42-1·71], p=7·65 × 10-20) within the class II MHC region were associated with pulmonary arterial hypertension. The SOX17 locus had two independent signals associated with pulmonary arterial hypertension (rs13266183, 1·36 [1·25-1·48], p=1·69 × 10-12; and rs10103692). Functional and epigenomic data indicate that the risk variants near SOX17 alter gene regulation via an enhancer active in endothelial cells. Pulmonary arterial hypertension risk variants determined haplotype-specific enhancer activity, and CRISPR-mediated inhibition of the enhancer reduced SOX17 expression. The HLA-DPA1/DPB1 rs2856830 genotype was strongly associated with survival. Median survival from diagnosis in patients with pulmonary arterial hypertension with the C/C homozygous genotype was double (13·50 years [95% CI 12·07 to >13·50]) that of those with the T/T genotype (6·97 years [6·02-8·05]), despite similar baseline disease severity.InterpretationThis is the first study to report that common genetic variation at loci in an enhancer near SOX17 and in HLA-DPA1/DPB1 is associated with pulmonary arterial hypertension. Impairment of SOX17 function might be more common in pulmonary arterial hypertension than suggested by rare mutations in SOX17. Further studies are needed to confirm the association between HLA typing or rs2856830 genotyping and survival, and to determine whether HLA typing or rs2856830 genotyping improves risk stratification in clinical practice or trials.FundingUK NIHR, BHF, UK MRC, Dinosaur Trust, NIH/NHLBI, ERS, EMBO, Wellcome Trust, EU, AHA, ACClinPharm, Netherlands CVRI, Dutch Heart Foundation, Dutch Federation of UMC, Netherlands OHRD and RNAS, German DFG, German BMBF, APH Paris, INSERM, Université Paris-Sud, and French ANR.

ISCP2019

Poster ISCP 2019

ISCP2019