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Background: Patients receiving dialysis have unmet palliative care needs. Limited access to palliative care is a key barrier to its integration into routine dialysis care. Objective: To determine the feasibility and acceptability of telepalliative care in rural dialysis units. Methods: This was a single-arm pilot clinical trial. The target population was patients with kidney failure receiving outpatient dialysis in a rural U.S. state. Feasibility was measured by one-month completion rate. Acceptability was measured using an adapted telemedicine questionnaire. Results: We recruited 39 patients with mean age 71.2 years to undergo a telepalliative care consultation while receiving dialysis. Four specialty palliative care clinicians (three physicians and one nurse practitioner) conducted the visits. The recruitment rate was 40% (39/96), scheduling rate was 100% (39/39), and one-month completion rate was 77% (30/39). Thirty-six patient participants (14 women and 22 men) completed the baseline survey. Audiovisual aspects of the visit were rated highly. More than 80% reported the visit being at least as good as an in-person visit and 41% felt the teleconsult was better. Eighty-one percent of patients felt the appointment was relevant to them, 58% felt they learned new things about their condition, and 27% reported the appointment changed the way they think about dialysis. Discussion: Telepalliative care is acceptable to patients receiving dialysis and is a feasible approach to integrating palliative care in rural dialysis units. The study was registered with Clinicaltrials.gov (NCT03744117).

Parler d’offre en matière d’enregistrement audiovisuel de théâtre musical et d’opéra semblait un peu réducteur. C’est pourquoi il a semblé bon d’élargir le thème pour voir la question de la production dans son ensemble et non pas du seul point de vue de la disponibilité des œuvres. La production audiovisuelle prend en compte non seulement l’offre du marché – il suffit pour cela de se référer aux différents catalogues des grands distributeurs – mais aussi les productions fossiles, qui ont perm...

Dans le cadre des Entretiens Jacques Cartier, le colloque Opéra Mundi a été conçu par l’Observatoire européen de géopolitique, en symphonie avec l’opéra de Lyon, pour repenser la géographie culturelle et l’économie de l’opéra, dans une approche à plusieurs voix. De la mode au cinéma, de la psychanalyse à la littérature, de la géopolitique à l’économie des biens culturels, l’opéra est un art d’ouvertures : carrefour des arts et des nations, de leurs langues officielles et de leurs cultures particulières. Phénomène européen, il a vu sa diffusion s’élargir au fil des courants économiques et migratoires. L’opéra a ses lieux, réels et mythiques, ses publics, ses marchés. L’art lyrique aborde le prochain siècle en s’ouvrant aux moyens modernes de communication. La voix de l’autre ne cessera donc de nous fasciner. Par sa capacité à franchir les frontières culturelles, l’opéra est investi d’une fonction civique, puisqu’il nous invite, l’espace d’un soir, à la multi-appartenance. Alors l’écoute et l’ouverture participent de ce que l’on appelle la civilisation.

Gene delivery as a therapeutic tool continues to advance toward impacting human health, with several gene therapy products receiving FDA approval over the past 5 years. Despite this important progress, the safety and efficacy of gene therapy methodology requires further improvement to ensure that nucleic acid therapeutics reach the desired targets while minimizing adverse effects. Synthetic polymers offer several enticing features as nucleic acid delivery vectors due to their versatile functionalities and architectures and the ability of synthetic chemists to rapidly build large libraries of polymeric candidates equipped for DNA/RNA complexation and transport. Current synthetic designs are pursuing challenging objectives that seek to improve transfection efficiency and, at the same time, mitigate cytotoxicity. This Perspective will describe recent work in polymer-based gene complexation and delivery vectors in which cationic polyelectrolytes are modified synthetically by introduction of additional components─including hydrophobic, hydrophilic, and fluorinated units─as well as embedding of degradable linkages within the macromolecular structure. As will be seen, recent advances employing these emerging design strategies are promising with respect to their excellent biocompatibility and transfection capability, suggesting continued promise of synthetic polymer gene delivery vectors going forward.

The paper studies tax evasion in an evolutionary setting. In addition to standard variables such as the fine individuals may have to pay if found guilty or the probability of being audited, agents' inclination to engage in tax evasion may also be affected by social interactions. Moreover, expected payoffs may include reputational costs or rewards awarded by society after an individual is audited. The paper shows how (i) social norms may play a very important role in defining the long-run evolution of tax evasion and, consequently, that (ii) policymakers should consider reforms that would increase social awareness and information rather than more (financially and politically) expensive traditional auditing instruments; in addition, (iii) fiscal/auditing policies should be carefully tailored to the particular economic and social setting in place in a country. Web of Science 89 4 405 385

Background and Hypothesis: Elevated plasma apoB-lipoproteins (hyperapoB, mostly LDL) predicts the incidence of type 2 diabetes (T2D) and its risk factors including systemic activation of the interleukin-1 system (measured as plasma IL-1 receptor antagonist, IL-1Ra) . Moreover, native LDL induce white adipose tissue (WAT) dysfunction. Underlying mechanisms for these findings remain unclear. Activation of WAT NLRP3 inflammasome and secretion of IL-1β promotes WAT dysfunction and related risk factors for T2D. We hypothesized that native LDL upregulate WAT NLRP3 inflammasome/IL-1β pathway. Methods: This data represents baseline analysis of a 3-month clinical trial with omega-3 fatty acid supplementation in nondiabetic men (N=13) and women (N=27) . We assessed insulin secretion and sensitivity by Botnia clamps, postprandial fat metabolism after a high-fat-meal (68% fat) , and priming and/or activation of NLRP3 inflammasome in subject hip WAT biopsies ex vivo using native LDL, lipopolysaccharides (LPS) (priming control) and/or ATP (activation control) . Results: Incubation of WAT with native LDL (1.2 g apoB/L) increased IL-1β secretion in ATP- but not LPS-treated WAT. Subjects with higher than median plasma apoB (1.23±0.15 g/L) had higher WAT IL-1β-secretion than those with lower apoB, using multiple combination of LDL, LPS and/or ATP, independent of adiposity, macronutrient intake or plasma lipids. WAT NLRP3 mRNA expression and IL-1β secretion correlated positively with hyperinsulinemia, insulin resistance, postprandial hypertriglyceridemia and hyperchylomicronemia and plasma IL-1Ra. Adjusting for sex and WAT IL-1β-secretion or sex and plasma IL-1Ra eliminated the association of plasma apoB with these risk factors (except hypertriglyceridemia) . Conclusion: Native LDL are priming signals of WAT NLRP3 inflammasome, which may explain higher risk for T2D in subjects with hyperapoB. ClinicalTrials.gov (NCT04496154) . Disclosure S.Bissonnette: None. V.Lamantia: None. Y.Cyr: None. M.Devaux: None. R.Rabasa-lhoret: Consultant; HLS Therapeutics Inc., Pfizer Inc., Other Relationship; Abbott Diabetes, AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Janssen Pharmaceuticals, Inc., Medtronic, Merck & Co., Inc., Novo Nordisk Canada Inc., Sanofi, Vertex Pharmaceuticals Incorporated, Research Support; Canadian Institutes of Health Research, Cystic Fibrosis Canada, Diabetes Canada, Fondation Francophone pour la Recherche en Diabète (FFRD) , JDRF, National Institutes of Health, Société Francophone du Diabète (SFD) , Speaker's Bureau; Canadian Medical & Surgical Knowledge Translation Research Group (CMS) , CPD Network, Tandem Diabetes Care, Inc. M.Chretien: None. M.Saleh: None. M.Faraj: None. Funding Canadian Institutes of Health Research (CIHR) (FRN# 123409)

BACKGROUND/OBJECTIVES The number of older adults with complex health needs is growing, and this population experiences disproportionate morbidity and mortality. Interventions led by community health workers (CHWs) can improve clinical outcomes in the general adult population with multimorbidity, but few studies have investigated CHW-delivered interventions in older adults. DESIGN We systematically reviewed the impact of CHW interventions on health outcomes among older adults with complex health needs. We searched for English-language articles from database inception through April 2020 using seven databases. PROSPERO protocol registration CRD42019118761. SETTING Any U.S. or international setting, including clinical and community-based settings. PARTICIPANTS Adults aged 60 years or older with complex health needs, defined in this review as multimorbidity, frailty, disability, or high-utilization. INTERVENTIONS Interventions led by a CHW or similar role consistent with the American Public Health Association's definition of CHWs. MEASUREMENTS Pre-defined health outcomes (chronic disease measures, general health measures, treatment adherence, quality of life, or functional measures) as well as qualitative findings. RESULTS Of 5671 unique records, nine studies met eligibility criteria, including four randomized controlled trials, three quasi-experimental studies, and two qualitative studies. Target population and intervention characteristics were variable, and studies were generally of low-to-moderate methodological quality. Outcomes included mood, functional status and disability, social support, well-being and quality of life, medication knowledge, and certain health conditions (e.g., falls, cognition). Results were mixed with several studies demonstrating significant effects on mood and function, including one high-quality RCT, while others noted no significant intervention effects on outcomes. CONCLUSION CHW-led interventions may have benefit for older adults with complex health needs, but additional high-quality studies are needed to definitively determine the effectiveness of CHW interventions in this population. Integration of CHWs into geriatric clinical settings may be a strategy to deliver evidence-based interventions and improve clinical outcomes in complex older adults.

Melanins are a class of biopolymers that are widespread in nature, with diverse origins, compositions, and functions, and their chemical and optoelectronic properties render them potentially useful for application in materials science for various biotechnological applications. For patients with alkaptonuria, the accumulation of homogentisic acid (HGA) in their bodies is associated with the concomitant deposition of pyomelanin, which is a pigment that contains significant amounts of polymerized HGA (polyHGA) in the bodily tissues of the patients. The polymerization of HGA under various different conditions in vitro is investigated using a selection of different analytical chemistry techniques to understand if there may be a correlation between the conditions and pigment deposition in vivo, and their potential for application as green/sustainable and components of electronic devices.

Thin films comprising synthetically robust, scalable molecules have been shown to have major potential for thermoelectric energy harvesting. Previous studies of molecular thin-films have tended to focus on massively parallel arrays of discrete but identical conjugated molecular wires assembled as a monolayer perpendicular to the electrode surface and anchored via a covalent bond, know as self-assembled monolayers. In these studies, to optimise the thermoelectric properties of the thin-film there has been a trade-off between synthetic complexity of the molecular components and the film performance, limiting the opportunities for materials integration into practical thermoelectric devices. In this work, we demonstrate an alternative strategy for enhancing the thermoelectric performance of molecular thin-films. We have built up a series of films, of controlled thickness, where the basic units—here zinc tetraphenylporphyrin—lie parallel to the electrodes and are linked via π–π stacking. We have compared three commonly used fabrications routes and characterised the resulting films with scanning probe and computational techniques. Using a Langmuir-Blodgett fabrication technique, we successfully enhanced the thermopower perpendicular to the plane of the ZnTPP multilayer film by a factor of 10, relative to the monolayer, achieving a Seebeck coefficient of −65 μV K−1. Furthermore, the electronic transport of the system, perpendicular to the plane of the films, was observed to follow the tunnelling regime for multi-layered films, and the transport efficiency was comparable with most conjugated systems. Furthermore, scanning thermal microscopy characterisation shows a factor of 7 decrease in thermal conductance with increasing film thickness from monolayer to multilayer, indicating enhanced thermoelectric performance in a π–π stacked junction.