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Leo Delaire,1,&ast; Aymeric Courtay,1,&ast; Mathieu Fauvernier,2,3 Joannès Humblot,1,&ast; Marc Bonnefoy1,4,5 1Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service de médecine du vieillissement, Pierre-Bénite, cedex F-69495, France; 2UMR CNRS 5558, Université Claude Bernard Lyon 1, Villeurbanne, 69100, France; 3Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service de Biostatistique – Bioinformatique, Pierre-Bénite, cedex F-69495, France; 4Inserm 1060-CarMeN, Université Claude Bernard Lyon 1, Villeurbanne, 69100, France; 5Université Claude Bernard Lyon 1, Villeurbanne, 69100, France&ast;These authors contributed equally to this workCorrespondence: Leo Delaire; Aymeric Courtay 165, Chemin du Grand Revoyet Tel +33 4 78 86 39 46Email leo.delaire@chu-lyon.fr; aymeric.courtay@chu-lyon.frIntroduction: Exercise and nutrition are the best targets to tackle mobility issues in community-dwelling older adults. As exercise response relies on multiple factors, improving the understanding of their interactions is a necessity to tailor effective preventive strategies. Based on a prevention care path designed for community-dwelling older adults with mobility disability risk, our main goal was to determine the predictive factors of the response to a multimodal intervention, combining structured exercise training and nutritional counselling. Thus, this study aimed to tailor prevention programs for non-responder participants.Methods: We analyzed the response of participants to a prevention program and built a multivariate predictive model to highlight the profile of the best responders. The model was based on the likelihood of at least 1 point of short physical performance battery (SPPB) score gain. Inclusion criteria were being aged ≥ 70 years and having completed a multicomponent group-based supervised training consisting of 20 sessions (10 weeks).Results: A total of 103 participants were included, their mean ± SD age was 81.9 ± 5.7 years. The model demonstrated interactions between baseline SPPB score (OR=0.42; p < 0.001), body mass index (BMI; OR=0.82; p=0.003), and grip strength value (OR=1.15; p=0.008). The highest probability of response was found for participants with low SPPB, normal BMI (21 kg/m2), and high grip strength (27 kg).Conclusion: This study demonstrated that the response to a multimodal intervention in community-dwelling older adults with mobility disability risk was influenced by the baseline SPPB score, BMI, and grip strength value. To increase the proportion of responders, strategies that could be more effective include constituting more homogenous group, and implementing a specific approach for obese sarcopenic older adults and those with low grip strength by increasing the dose of physical activity and monitoring endurance and mobility activities between sessions. Our results provide important consideration for the development of targeted-interventions.Keywords: exercise, nutrition, prevention, responders profiles

Thomas Gilbert,1 Antoine Bosquet,2 Catherine Thomas-Antérion,3,4 Marc Bonnefoy,1 Olivia Le Saux1 1Geriatric Department, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France; 2Internal Medicine Unit, AP-HP – Louis Mourier Hospital, Colombes, France; 3Plein Ciel, Lyon, France; 4Laboratory for the Study of Cognitive Mechanisms, Lyon 2 University, Lyon, France Background: The number of clinical trials including older patients, and particularly patients with cognitive impairment, is increasing. While statutory provisions exist to make sure that the capacity to consent is assessed systematically for each patient, many gray areas remain with regard to how this assessment is made or should be made in the routine practice of clinical research. Objectives: The aim of this review was to draw up an inventory of assessment tools evaluating older patients’ capacity to consent specifically applicable to clinical research, which could be used in routine practice. Methods: Two authors independently searched PubMed, Cochrane, and Google Scholar databases between November 2015 and January 2016. The search was actualized in April 2017. We used keywords (MeSH terms and text words) referring to informed consent, capacity to consent, consent for research, research ethics, cognitive impairment, vulnerable older patients, and assessment tools. Existing reviews were also considered. Results: Among the numerous existing tools for assessing capacity to consent, 14 seemed potentially suited for clinical research and six were evaluated in older patients. The MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) was the most frequently cited. Conclusion: The MacCAT-CR is currently the most used and the best validated questionnaire. However, it appears difficult to use and time-consuming. A more recent tool, the University of California Brief Assessment of Capacity to Consent (UBACC), seems interesting for routine practice because of its simplicity, relevance, and applicability in older patients. Keywords: aged, assessment tools, clinical research, decision-making capacity

Olivia Le Saux,1 Bertrand Ripamonti,2 Amandine Bruyas,3,4 Olivier Bonin,4 Gilles Freyer,1,4 Marc Bonnefoy,4,5 Claire Falandry4,51Medical Oncology Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, 2Gynaecology-Obstetrics Department, University Hospital, Saint-Etienne, 3Croix Rousse University Hospital, Hospices Civils de Lyon, Pierre-Bénite, 4Lyon University, Lyon, 5Geriatric Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, FranceAbstract: Breast cancer (BC) is the most common female malignancy in the world and almost one third of cases occur after 70 years of age. Optimal management of BC in the elderly is a real challenge and requires a multidisciplinary approach, mainly because the elderly population is heterogeneous. In this review, we describe the various possibilities of treatment for localized or metastatic BC in an aging population. We provide an overview of the comprehensive geriatric assessment, surgery, radiotherapy, and adjuvant therapy for early localized BC and of chemotherapy and targeted therapies for metastatic BC. Finally, we attempt to put into perspective the necessary balance between the expected benefits and risks, especially in the adjuvant setting.Keywords: elderly, breast cancer, geriatric assessment, surgery, chemotherapy, radiotherapy

B Aguilaniu1, J Gonzalez-Bermejo2, A Regnault3, C Dias Barbosa3, B Arnould3, M Mueser4, G Granet5, M Bonnefoy6, T Similowski2,71HYLAB, Physiologie Clinique, Grenoble, France; 2Assistance Publique – Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Pneumologie et Réanimation, Paris, France; 3Mapi Values, Lyon, France; 4Formerly Boehringer Ingelheim, Paris, France; 5General Practitioner, Sainte-Foy-lès-Lyon, Paris, France; 6Centre Hospitalier Lyon Sud, Lyon, France; 7Université Paris 6 Pierre et Marie Curie, ER10, Paris, FranceBackground: Chronic Obstructive Pulmonary Disease (COPD) is a worldwide public health concern. It is also a major source of disability that is often overlooked, depriving patients of effective treatments. This study describes the development and validation of a questionnaire specifically assessing COPD-related disability.Methods: The DIsability RElated to COPD Tool (DIRECT) was developed according to reference methods, including literature review, patient and clinician interviews and test in a pilot study. A 12-item questionnaire was included for finalization and validation in an observational cross-sectional study conducted by 60 French pulmonologists, who recruited 275 COPD patients of stage II, III and IV according to the GOLD classification. Rasch modeling was conducted and psychometric properties were assessed (internal consistency reliability; concurrent and clinical validity).Results: The DIRECT score was built from the 10 items retained in the Rasch model. Their internal consistency reliability was excellent (Cronbach's alpha = 0.95). The score was highly correlated with the Saint George's Respiratory Questionnaire Activity score (r = 0.83) and the London Handicap Scale (r = –0.70), a generic disability measure. It was highly statistically significantly associated to four clinical parameters (P < 0.001): GOLD classification, BODE index, FEV1 and 6-minute walk distance.Conclusion: DIRECT is a promising tool that could help enhance the management of COPD patients by integrating an evaluation of the COPD-related disability into daily practice.Keywords: chronic obstructive pulmonary disease, daily medical practice, disability, disease management, questionnaires

Context. Dual-field interferometric observations with VLTI/GRAVITY sometimes require the use of a binary calibrator. This is a binary star whose individual components remain unresolved by the interferometer, with a separation between 400 and 2000 mas for observations with the Unit Telescopes (UTs), or 1200–3000 mas for the Auxiliary Telescopes (ATs). The separation vector also needs to be predictable to within 10 mas for a proper pointing of the instrument. Aims. No list of properly vetted calibrators was available so far for dual-field observations with VLTI/GRAVITY on the UTs. Our objective is to compile such a list and make it available to the community. Methods. We identified a list of candidates from the Washington Double Star (WDS) catalogue, all with appropriate separations and brightness, scattered over the southern sky. We observed them as part of a dedicated calibration programme, determined whether these objects were true binaries (excluding higher multiplicities resolved interferometrically, but unseen by imaging), and extracted measurements of the separation vectors. We combined these new measurements with those available in the WDS to determine updated orbital parameters for all our vetted calibrators. Results. We compiled a list of 13 vetted binary calibrators for observations with VLTI/GRAVITY on the UTs, and we provide orbital estimates and astrometric predictions for each of them. We show that our list guarantees that there are always two binary calibrators at least at an airmass < 2 in the sky over the Paranal observatory at any point in time. Conclusions. Any principal investigator wishing to use the dual-field mode of VLTI/GRAVITY with the UTs can now refer to this list to select an appropriate calibrator. We encourage the use of whereistheplanet to predict the astrometry of these calibrators, which seamlessly integrates with p2Gravity for VLTI/GRAVITY dual-field observing material preparation. [ABSTRACT FROM AUTHOR]

Molecular mapping is a supervised method exploiting the spectral diversity of integral field spectrographs to detect and characterise resolved exoplanets blurred into the stellar halo. We present an update to the method, aimed at removing the stellar halo and the nuisance of telluric features in the datacubes and accessing a continuum-subtracted spectra of the planets at R ~ 4000. We derived the planet atmosphere properties from a direct analysis of the planet telluric-corrected absorption spectrum. We applied our methods to the SINFONI observation of the planet β Pictoris b. We recovered the CO and H2O detections in the atmosphere of β Pic b by using molecular mapping. We further determined some basic properties of its atmosphere, with Teq=1748−4+3 K, sub-solar [Fe/H]=− 0.235−0.013+0.015 dex, and solar C/O=0.551 ±0.002. These results are in contrast to values measured for the same exoplanet with other infrared instruments. We confirmed a low projected equatorial velocity of 25−6+5 km s−1. We were also able to measure, for the first time and with a medium-resolution spectrograph, the radial velocity of β Pic b relative to the central star at MJD=56910.38 with a km s−1 precision of −11.3±1.1 km s−1. This result is compatible with the ephemerides, based on the current knowledge of the β Pic system. [ABSTRACT FROM AUTHOR]

We report kinematic and thermal signatures associated with the directly imaged protoplanet candidate in the Elias 2–24 disc. Using the DSHARP (Disc Substructures at High Angular Resolution Project) ALMA (Atacama Large Millimetre/submillimetre Array) observations of the 12CO J = 2 − 1 line, we show that the disc kinematics are perturbed, with a detached CO emission spot at the location of the planet candidate and traces of spiral wakes, and also that the observed CO emission intensities require local heating. While the foreground extinction hides the velocity channels associated with the planet, preventing a planet mass estimate, the level of gas heating implied by the CO emission indicates the presence of a warm, embedded giant planet. Comparison with models shows that this could either be a ≳5 MJup or a lower mass (≳2 MJup) but accreting protoplanet. [ABSTRACT FROM AUTHOR]

Context. Orbital motion in binary and planetary systems is the main source of precise stellar and planetary mass measurements, and the joint analysis of data obtained using multiple observational methods can both lift degeneracies and improve precision. Aims. We set out to measure the masses of individual stars in binary systems using all the information brought by the HIPPARCOS and Gaia absolute astrometric missions. Methods. We present BINARYS, a tool that uses the HIPPARCOS and Gaia absolute astrometric data and combines them with relative astrometry and/or radial velocity measurements to determine the orbit of a binary system. This tool rigorously combines the HIPPARCOS and Gaia data (here EDR3) and can use the HIPPARCOS Transit Data as needed for binaries where HIPPARCOS detects significant flux from the secondary component. It also supports the case where Gaia has resolved the system, giving an astrometric solution for both components. Results. We determine model-independent individual masses for the first time for three systems: the two mature binaries Gl 494 (M1 = 0.584 ± 0.003 Mand M2 = 87 ± 1 MJup) and HIP 88745 (M1 = 0.96 ± 0.02 Mand M2 = 0.60+0.02 -0.01 M), and the younger AB Dor member GJ 2060 (M1 = 0.60+0.06 -0.05 M and M2 = 0.45+0.06 -0.05 M). The latter provides a rare test of evolutionary model predictions at young ages in the low-stellar-mass range and sets a lower age limit of 100 Myr for the moving group. [ABSTRACT FROM AUTHOR]

Aims. HD 206893 is a nearby debris disk star that hosts a previously identified brown dwarf companion with an orbital separation of ∼10 au. Long-term precise radial velocity (RV) monitoring, as well as anomalies in the system proper motion, has suggested the presence of an additional, inner companion in the system. Methods. Using information from ongoing precision RV measurements with the HARPS spectrograph, as well as Gaia host star astrometry, we have undertaken a multi-epoch search for the purported additional planet using the VLTI/GRAVITY instrument. Results. We report a high-significance detection over three epochs of the companion HD 206893c, which shows clear evidence for Keplerian orbital motion. Our astrometry with ∼50−100 μarcsec precision afforded by GRAVITY allows us to derive a dynamical mass of 12.7 − 1.0 + 1.2 $ ^{+1.2}_{-1.0} $ MJup and an orbital separation of 3.53 − 0.06 + 0.08 $ ^{+0.08}_{-0.06} $ au for HD 206893c. Our fits to the orbits of both companions in the system use both Gaia astrometry and RVs to also provide a precise dynamical estimate of the previously uncertain mass of the B component, and therefore allow us to derive an age of 155 ± 15 Myr for the system. We find that theoretical atmospheric and evolutionary models that incorporate deuterium burning for HD 206893c, parameterized by cloudy atmosphere models as well as a "hybrid sequence" (encompassing a transition from cloudy to cloud-free), provide a good simultaneous fit to the luminosity of both HD 206893B and c. Thus, accounting for both deuterium burning and clouds is crucial to understanding the luminosity evolution of HD 206893c. Conclusions. In addition to using long-term RV information, this effort is an early example of a direct imaging discovery of a bona fide exoplanet that was guided in part by Gaia astrometry. Utilizing Gaia astrometry is expected to be one of the primary techniques going forward for identifying and characterizing additional directly imaged planets. In addition, HD 206893c is an example of an object narrowly straddling the deuterium-burning limit but unambiguously undergoing deuterium burning. Additional discoveries like this may therefore help clarify the discrimination between a brown dwarf and an extrasolar planet. Lastly, this discovery is another example of the power of optical interferometry to directly detect and characterize extrasolar planets where they form, at ice-line orbital separations of 2−4 au. [ABSTRACT FROM AUTHOR]

Brown dwarfs--substellar bodies more massive than planets but not massive enough to initiate the sustained hydrogen fusion that powers self-luminous stars (1, 2)--are born hot and slowly cool as they [...]

Introduction Pressure sores remain a considerable problem in geriatric medicine [1] owing to their frequency and severity. The pressure-time product is of fundamental importance in initiating ischaemia and tissue necrosis [...]