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Abstract Background The ageing population, coupled with the desire to age-in-place, highlight the need for programs that target health promotion as a means of maintaining functional ability, autonomy, and independence among community-dwelling older adults. This paper describes the development of the VIeSA intervention, which aimed to model a healthy ageing trajectory, including the identification of the necessary tools and methods, that would allow people older people, in partnership with health and social care professionals, to define personal health-related goals and the actions to achieve them. A key element of the intervention development was the creation of a support tool intended to assist this process. Methods The UK Medical Research Council (MRC) guidance on developing and evaluating complex interventions was applied in the development of the intervention and of the support tool. A participatory approach was selected, with stakeholders engaged on different occasions to allow the refinement of the intervention and of the support tool. Following the steps and suggested actions in the MRC development phase, the development process was conducted by identifying (1) the evidence base and (2) the theoretical framework and (3) by modelling the process and outcomes of the intervention. Results Following a literature review on effective interventions for functional ability, draft 1 of the support tool was designed. Focus groups with stakeholders provided feedback on this draft allowing for its refinement in terms of content, language use, and structure (draft 2). A review of the approaches for health promotion delivery led to further additions to the tool (draft 3) and informed the content of the training of health and social care professionals. After their training, professionals provided feedback on the acceptability, appropriateness, and feasibility of different elements of the intervention. Results suggested that no further major refinement to the intervention or support tool was necessary. Conclusions The design and development of the VIeSA intervention using the MRC guidance allowed for a clarity of direction, an optimised content in terms of usefulness and accessibility for all concerned stakeholders, and greater opportunities for its implementation and uptake.

Most investigations on the immune cell-activating potency of IgA used purified total IgA and/or specific isolated cell populations. As IgA2 has been reported to be more pro-inflammatory than IgA1, we aimed to employ a fast and convenient whole blood-based assay to individually probe the capacity of the two IgA subclasses to activate immune cells in close physiological conditions. To this end, whole blood from healthy donors (n = 10) was stimulated with immobilized IgA1, IgA2m1 or IgA2m2 (the two main allotypic variants of IgA2). Activation of major leukocyte subsets was measured using a 10-color flow cytometry panel providing access to the expression of 5 activation markers on 6 different immune cell subsets. While capturing some heterogeneity of responses among donors, IgA2m1 and IgA2m2 systematically showed a stronger activation profile compared to IgA1 in a variety of dimensions. For example, both IgA2 allotypes led to stronger modulations of CD54, CD11b, CD62L, CD66b or CD69, on both or either monocytes or neutrophils, indicating a more pronounced pro-inflammatory effect for this subclass than IgA1. By taking into account donor-specific soluble and cellular components this whole blood-based functional approach provides new perspectives to further investigate IgA effector functions in mechanistic studies and/or translational research.

Abstract Objective: Undernutrition, stunted growth and obesity remain a concern in Algeria. Currently, limited data are available on nutrient intakes among children. Our study aimed to describe food and nutrient intakes and the role of milk formulas among Algerian children. Design: Dietary intakes were collected using a 4-d interview-based survey for children aged 0–24 months, living in urban areas in Algeria in 2019. Setting: Food consumptions were described. For children aged 6–24 months, nutrient intakes and adequacy were estimated. Modelling was used to estimate the nutritional impact of substituting cow’s milk for age-appropriate infant formulas (IF). Participants: Totally, 446 children aged 0–24 months. Results: Before 6 months, 91·6 % of infants were breastfed. Breastmilk was also the main milk consumed between 6 and 12 months, whereas cow’s milk predominated after 12 months. In children aged 6–24 months, nutrient adequacy prevalence was above 75 % for the majority of nutrients. However, less than 30 % of the children had adequate intakes for total fats, Fe and vitamin D. Simulated substitution of cow’s milk for IF led to improved adequacy for proteins, Fe, and vitamins D and E. Conclusions: Our study showed that breast-feeding rates were high until 6 months, then declined with age. Consumed foods allowed Algerian children aged 6–24 months to meet most of their nutritional needs, but inadequate intakes were reported for some key nutrients. Our modelling suggested that milk formulas may help to improve nutrient adequacy among non-breastfed infants. Other dietary changes could also be further investigated to enable children to meet all nutritional recommendations.

Abstract A strong bias related to age is observed in COVID-19 patients with pediatric subjects developing a milder disease than adults. We hypothesized that a specific SARS-CoV-2 effect conjugated with preexisting differences in the immune systems may explain this. Using flow cytometry, we investigated basal immune differences in a cohort consisting of 16 non-infected young and 16 aged individuals and further leveraged an in vitro whole blood model of SARS-CoV-2 infection so that functional differences could be mined as well. In short, blood diluted in culture media was incubated 5 or 24 h with the trimeric spike protein or controls. Following unsupervised analysis, we first confirmed that the immune lymphoid and myeloid systems in adults are less efficient and prone to develop higher inflammation than those in children. We notably identified in adults a higher CD43 lymphocyte expression, known for its potentially inhibitory role. The spike protein induced different responses between adults and children, notably a higher increase of inflammatory markers together with lower monocyte and B cell activation in adults. Interestingly, CD169, a CD43 ligand overexpressed in COVID-19 patients, was confirmed to be strongly modulated by the spike protein. In conclusion, the spike protein exacerbated the preexisting lower immune responsiveness and higher inflammatory potential in adults. Altogether, some of the markers identified may explain the marked age bias and be predictive of severity.

Since the 1970s, drug-producing regions have been the target of ‘alternative development' policies. These policies aim to provide alternative crops to illegal coca, poppy, and marijuana growers, but also to initiate a greater development process in the regions concerned. The redefinition of these policies in international arenas has been widely studied, but little is known about the representations that farmers have of these policies in the production regions. This contribution proposes to overcome these limitations by examining more directly the effects of these policies at the subnational level. To this end, the case of the Valley of the Apurimac, Ene and Mantaro Rivers (VRAEM), Peru’s main illegal coca-producing region and a post-conflict area, is analyzed. Despite an apparent consensus on development at the subnational level, tensions remain around these policies and their administration and occasionally arise between the Peruvian state and social organizations. This article shows that the implementation of development policies generates mistrust among farmers due to the ambiguity of the future of crops and the uncertainty of the benefits derived from development programs. The distrust is mainly directed at the agents in charge of implementing the programs and the leaders of social organizations who act as intermediaries. Because these policies largely exclude collective actors, they undermine trust in political representation and the Peruvian state in a region still weakened by the post-conflict context. Resumen: Desconfianza del desarrollo en las regiones cocaleras de Perú: El valle de los ríos Apurimac, Ene y Mantaro Desde la década de 1970, las regiones productoras de drogas han sido objeto de políticas de “desarrollo alternativo”, que pretenden ofrecer cultivos alternativos a los cultivadores ilegales de coca, amapola y marihuana, pero también iniciar un proceso de desarrollo mayor en las regiones afectadas. La redefinición de estas políticas en el ámbito internacional ha sido ampliamente estudiada, pero poco se sabe de las representaciones que los campesinos tienen de estas políticas en las regiones productoras. Esta contribución propone superar estas limitaciones examinando más directamente los efectos de estas políticas a nivel subnacional. Para ello, se analiza el caso del Valle de los ríos Apurímac, Ene y Mantaro (VRAEM), principal región productora de coca ilegal de Perú y zona de post-conflicto. A pesar de un aparente consenso sobre el desarrollo a nivel subnacional, siguen existiendo tensiones en torno a estas políticas y su administración, y en ocasiones surgen entre el estado peruano y las organizaciones sociales. Este artículo muestra que la aplicación de las políticas de desarrollo genera desconfianza entre los agricultores debido a la ambigüedad del futuro de los cultivos y a la incertidumbre de los beneficios derivados de los programas de desarrollo. La desconfianza se dirige principalmente a los agentes encargados de aplicar los programas y a los dirigentes de las organizaciones sociales que actúan como intermediarios. Estas políticas, al excluir en gran medida a los actores colectivos, minan la confianza en la representación política y en el Estado peruano, en una región aún debilitada por el contexto post-conflicto.

Abstract Despite introduction of biological disease modifying anti-rheumatic drugs (DMARDs) for Rheumatoid arthritis (RA) treatment, therapeutic strategies do not always lead to disease control and remission. Hence, a more efficient patient stratification and monitoring biomarkers and tools are needed to enable a more personalized medicine. We used a whole blood based functional flow cytometry assay to characterize immune cells from RA patients (treated or not), healthy donors and psoriatic arthritis (PsA) patients according to their responses to LPS and/or anti-TNFα (infliximab, IFX). Activation marker expression was measured using a 10-color flow cytometry panel following a no-wash protocol. Naïve-to-treatment RA patients had a stronger inflammatory profile in comparison to healthy donors at basal level. Higher expression of activation markers (CD69 and/or CD11b) on NK, B cells and granulocytes and lower expression of the adhesion molecule CD62L were measured on monocytes, granulocytes and B cells. After LPS, naïve RA patients’ cells were less capable of regulating CD69, CD11b, CD16 or CD62L showing impaired activation capabilities. Upon LPS and IFX co-incubation, hierarchical clustering analysis showed different profiles between cohorts. We believe that this whole blood-based approach should further be assessed for RA patient characterization as it provides new perspectives for stratification and/or monitoring.

Introduction : Des indicateurs cliniques de fragilité et de complexité des situations de soins à domicile sont dérivés de l’interRAI HC, mais leur implémentation dans la pratique demande une analyse précise et préalable du contexte de soins dans lequel ils pourraient être utilisés. L’Implementation Research Logic Model (IRLM) est un cadre de référence mobilisable pour l’ensemble du processus d’implémentation notamment pour la pré-implémentation, une étape indispensable, bien que souvent négligée. Objectif : Cet article vise à présenter une démarche d’application du modèle IRLM qui précise les éléments clés (déterminants, stratégies, mécanismes et retombées) de l’étape de pré-implémentation. Démarche : L’implémentation prend place à l’institution genevoise de maintien à domicile (imad) en Suisse. Les données recueillies (ex. caractéristiques de l’institution, questionnaire auprès des infirmières) sont classées dans l’IRLM par un groupe de travail. Évaluation : L’analyse des éléments de pré-implémentation pointe les déterminants contextuels pouvant favoriser l’implémentation (ex. disponibilité des indicateurs cliniques et protocoles de prise en soins) ou la freiner (ex. multiplicité des informations). Par ailleurs, les stratégies mises en place et les retombées recueillies à ce stade (ex. intégration des indicateurs dans le dossier du patient, peu de résistance au changement) sont décrites. Discussion et conclusion : L’anticipation et l’analyse des conditions dans lesquelles prend place l’implémentation dès la phase de pré-implémentation permettent de recueillir des informations essentielles sur des recommandations d’adaptation des actions aux contextes spécifiques et aux réalités concrètes. La mise en place de stratégies étape par étape devrait contribuer à relever le défi du transfert de nouvelles connaissances à la pratique clinique contextualisée.

Abstract Background Person-centered care allows for the inclusion of the totality of a person’s needs and preferences, beyond just the clinical or medical aspect. This approach requires the development of tools to allow for the integration of the patient in his/her healthcare. Based on a 30-item tool developed for nurses to evaluate the complexity of home care situations (COMID), this study proposed a version for the patients (i.e. COMID-P). Both instruments were used, independently by nurses and patients, to rate the complexity of individual situations, in order to compare ratings. Methods The COMID-P and the COMID were completed during the fraXity study at the patients’ homes, independently by patients (aged 65 and over) and nurses. Item-level and scale-level analyses were performed using, Kappa and McNemar tests, and intra-class correlation (ICC). Results A total of 159 pairs of COMID and COMID-P ratings were retained for analyses. Results demonstrated a high degree of patient/nurse agreement for 12/30 items, a moderate agreement for 10/30 items, and a low degree of agreement for 7/30 items. The intra-class correlation between the COMID-P and the COMID was high (ICC= .826, 95%CI [.761-.873]). Conclusions The results demonstrate that patients and nurses can assess complexity using tools that have comparable structural properties. They also reveal congruencies and discrepancies in scoring the components of complexity, highlighting the need of reaching consensus in designing care plans. Further work is needed to demonstrate the benefits of joint assessment in developing care plans that truly meet patients’ needs. Trial registration The fraXity study was registered in ClinicalTrials.gov, NCT03883425 , on March 20, 2019.

OBJECTIVES:. To identify COVID-19-associated immunophenotyping patterns at hospital admission and to determine if some patterns could predict the need for mechanical ventilation (MV). DESIGN:. Prospective observational monocentric cohort study. SETTING:. A university-affiliated hospital in Marseille, France. PATIENTS:. Thirty patients presenting with laboratory-confirmed COVID-19 pneumonia were enrolled within the first 48 hours of hospital admission and compared with 18 healthy controls. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Whole-blood leukocytes were immunophenotyped with a rapid and simplified one-step flow cytometry method. Thirty-eight immune and five laboratory parameters were compared first between COVID-19 patients and controls and then between the COVID-19 patients who received or not MV during their stays. The variables that significantly discriminated MV from non-MV patients in univariate analysis were entered into a multiple stepwise logistic regression analysis. The COVID-19 patients were predominantly male (87%), aged 61 years (50–71 yr), and 93% received early corticosteroid therapy. Sixteen patients (53%) were managed with noninvasive respiratory support, and 14 (47%) required MV. Compared with controls, COVID-19 patients were characterized by an immune signature featuring: 1) decreased HLA-DR expression on monocytes; 2) reduced basophils, eosinophils, T-cells, NK cells, and nonclassical monocyte count; and 3) up regulation of CD169 on monocytes, CD64 on neutrophils, the adhesion/migration markers (CD62L and CD11b), and the checkpoint inhibitor CD274 on myeloid cells. Among the COVID-19 patients, those who received MV had lower level of CD4 and HLA-DR on monocytes, lower CD8+ T-cell count, and higher lactate dehydrogenase at hospital admission. In multivariate analysis, only CD4 on monocytes (p = 0.032) and CD8+ T-cell count (p = 0.026) were associated with MV requirement. The model combining these two variables provided an area under curve of 0.97 (95% CI, 0.83–0.99). CONCLUSIONS:. The association of low CD4 on monocytes and low CD8+ T-cell count at hospital admission was highly predictive of the need for MV in hospitalized patients with COVID-19 pneumonia.

Introduction : L’émergence de la COVID-19 a mis à l’épreuve les systèmes de soins. À Genève (Suisse), les services de soins infirmiers à domicile sont très mobilisés auprès des personnes les plus vulnérables pour faire face aux problématiques de dépistage, de vaccination, de prises en charge aigües et chroniques des plus fragiles. Objectif : Mise en place d’un dispositif spécifique de soins infirmiers pour répondre à une complexité et un continuum de prise en charge et d’intervention domiciliaire en situation de crise sanitaire COVID. Démarche : Un itinéraire clinique multimodal, interprofessionnel a été élaboré par l’institution genevoise de maintien à domicile et pour lequel les infirmières ont un rôle essentiel pour 1) le dépistage, 2) les soins durant la phase aigüe de l’infection, 3) le suivi post hospitalisation et la phase de réadaptation, 4) la vaccination des plus fragiles. Résultats : En décembre 2021, 81 infirmières sont intervenues auprès de : 1) 5 500 personnes pour le dépistage, 2) 6 600 patients pour des soins en phase aigüe, 3) 796 patients pour des soins post-hospitalisation et réadaptation, et 4) 2 200 personnes pour la vaccination. Les infirmières ont agi sur des axes préventifs (prévention de la contamination, repérage des risques de dénutrition, sédentarité, isolement, etc.), curatifs (aides et soins) et palliatifs (gestion des COVID longues) intégrant l’axe de coordination avec les différents acteurs de santé du réseau genevois. Discussion et conclusion : Ce dispositif piloté par les soins infirmiers à domicile a permis d’apporter des réponses cliniques et opérationnelles de proximité pour soulager les tensions hospitalières et maintenir à domicile des personnes vulnérables.

Objective: The COVID-19 corona virus disease outbreak is globally challenging health systems and societies. Its diagnosis relies on molecular methods, with drawbacks revealed by mass screening. Upregulation of neutrophil CD64 or monocyte CD169 has been abundantly reported as markers of bacterial or acute viral infection, respectively. We evaluated the sensitivity of an easy, one-step whole blood flow cytometry assay to measure these markers within 10 min, as a potential screening test for COVID-19 patients. Methods: Patients ( n = 177) with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were tested on 10 µL blood and results were compared with reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR). Results: We observed 98% and 100% sensitivity in early-stage ( n = 52) and asymptomatic patients ( n = 9), respectively. Late-stage patients, who presented for a second control RT-qPCR, were negative for both assays in most cases. Conversely, neutrophil CD64 expression was unchanged in 75% of cases, without significant differences between groups. Conclusion: Monocyte CD169 evaluation was highly sensitive for detecting SARS-CoV-2 infection in first-presentation patients; and it returns to basal level upon infection clearance. The potential ease of fingerprick collection, minimal time-to-result, and low cost rank this biomarker measurement as a potential viral disease screening tool, including COVID-19. When the virus prevalence in the tested population is usually low (1%−10%), such an approach could increase the testing capacity 10 to 100-fold, with the same limited molecular testing resources, which could focus on confirmation purposes only.

Abstract Aim Home care nurses often use the Resident Assessment Instrument‐Home Care (interRAI‐HC) to assess health needs. However, this tool does not assess complexity. This study proposes to derive a complexity index (CI) from the interRAI‐HC using the operational definition of the dedicated COMID checklist (COmplexité Multidimensionnelle des prises en soins Infirmières à Domicile). Design Data were collected at the baseline assessment of the fraXity study (N = 231, aged ≥ 65), which relied on an observational longitudinal design. Methods Measures were the interRAI‐HC, from which the CI binary variables were computed and the COMID, used as a reference. Results Twenty‐six CI variables were computed from the interRAI‐HC, and all but three correlations were significant. The correlation between the CI score and the COMID score was ρ = 0.730 (p

Phenotypic characteristics of a plant species refers to its physical properties as cataloged by plant biologists at different research centers around the world. Clustering species based upon their phenotypic characteristics is used to obtain diverse sets of parents that are useful in their breeding programs. The Hierarchical Clustering (HC) algorithm is the current standard in clustering of phenotypic data. This algorithm suffers from low accuracy and high computational complexity issues. To address the accuracy challenge, we propose the use of Spectral Clustering (SC) algorithm. To make the algorithm computationally cheap, we propose using sampling, specifically, Pivotal Sampling that is probability based. Since application of samplings to phenotypic data has not been explored much, for effective comparison, another sampling technique called Vector Quantization (VQ) is adapted for this data as well. VQ has recently generated promising results for genotypic data. The novelty of our SC with Pivotal Sampling algorithm is in constructing the crucial similarity matrix for the clustering algorithm and defining probabilities for the sampling technique. Although our algorithm can be applied to any plant species, we tested it on the phenotypic data obtained from about 2,400 Soybean species. SC with Pivotal Sampling achieves substantially more accuracy (in terms of Silhouette Values) than all the other proposed competitive clustering with sampling algorithms (i.e. SC with VQ, HC with Pivotal Sampling, and HC with VQ). The complexities of our SC with Pivotal Sampling algorithm and these three variants are almost the same because of the involved sampling. In addition to this, SC with Pivotal Sampling outperforms the standard HC algorithm in both accuracy and computational complexity. We experimentally show that we are up to 45% more accurate than HC in terms of clustering accuracy. The computational complexity of our algorithm is more than a magnitude less than that of HC.

Abstract Blood cell analysis is a major pillar of biomedical research and healthcare. These analyses are performed in central laboratories. Rapid shipment from collection site to the central laboratories is currently needed because cells and biomarkers degrade rapidly. The dried blood spot from a fingerstick allows the preservation of cellular molecules for months but entire cells are never recovered. Here leucocyte elution is optimized from dried blood spots. Flow cytometry and mRNA expression profiling are used to analyze the recovered cells. 50–70% of the leucocytes that are dried on a polyester solid support via elution after shaking the support with buffer are recovered. While red blood cells lyse upon drying, it is found that the majority of leucocytes are preserved. Leucocytes have an altered structure that is improved by adding fixative in the elution buffer. Leucocytes are permeabilized, allowing an easy staining of all cellular compartments. Common immunophenotyping and mRNAs are preserved. The ability of a new biomarker (CD169) to discriminate between patients with and without Severe Acute Respiratory Syndrome induced by Coronavirus 2 (SARS‐CoV‐2) infections is also preserved. Leucocytes from blood can be dried, shipped, and/or stored for at least 1 month, then recovered for a wide variety of analyses, potentially facilitating biomedical applications worldwide.

Flow cytometry is a powerful analytical technique that is increasingly used in scientific investigations and healthcare; however, it requires time-consuming, multi-step sample procedures, which limits its use to specialized laboratories. In this study, we propose a new universal one-step method in which white blood cell staining and red blood cell lysis are carried out in a single step, using a gentle lysis solution mixed with fluorescent antibody conjugates or probes in a dry or liquid format. The blood sample may be obtained from a routine venipuncture or directly from a fingerprick, allowing for near-patient analysis. This procedure enables the analysis of common white blood cell markers as well as markers related to infections or sepsis. This simpler and faster protocol may help to democratize the use of flow cytometry in the research and medical fields.Graphic abstract:One-step White Blood Cell Extracellular Staining Method for Flow Cytometry.

Abstract Background The early screening of frail individuals and of patients with complex care needs are challenges that countries witnessing population aging face. Homecare nurses are actors of choice in meeting these challenges, yet they need means of identifying frail and complex patients in their routine practice. The fraXity study’s aim is to fill this gap by (1) proposing frailty and complexity computation algorithms derived from the interRAI-HC; (2) assessing the predictive validity of the proposed indices with respect to adverse health outcomes; and (3) identifying subgroups of the aged population for whom the early screening of frailty and complexity appears to be most relevant. Methods The study will rely on a prospective observational case-control longitudinal study. Three samples of individuals aged 65 or older living in the community will be considered: recipients of formal home care (case 1), of formal home assistance (case 2) and individuals free of formal home services (controls). All participants will receive interRAI-HC assessments at three measurement occasions, separated by six-month intervals. Baseline assessments will serve to derive frailty and complexity scores. Follow-ups will serve to assess the predictive validity of the proposed indices and to estimate the intra-individual change in frailty and complexity. Group comparisons will serve to identify subgroups of the population for whom the screening of frailty and complexity appears to be the most relevant. Discussion The expected results of the fraXity study are a) reliable computation algorithms for frailty and complexity scores derived from the interRAI-HC and b) clinical assessment protocols for use by homecare nurses. These outcomes should contribute to outfitting key actors of the health system with means of enhancing their part in a collective endeavor targeting the best care and quality of life for aged citizens. Trial registration ClinicalTrials.gov, NCT03883425, registered on March 20, 2019.

Introduction Discussing the evolution of life-threatening diseases and end-of-life issues remains difficult for patients, relatives and professionals. Helping people discuss and formalise their preferences in end-of-life care, as planned in the Go Wish intervention, could reduce health-related anxiety in the advance care planning (ACP) and advance directive (AD) process. The aims of this study are (1) to test the effectiveness of the Go Wish intervention among outpatients in early-stage palliative care and (2) to understand the role of defence mechanisms in end-of-life discussions among nurses, patients and relatives.Methods and analysis A mixed-methods study will be performed. A cluster randomised controlled trials with three parallel arms will be conducted with 45 patients with chronic progressive diseases impacting life expectancy in each group: (1) Group A, Go Wish intervention for patients and their relatives; (2) Group A, Go Wish intervention for patients alone and (3) Group B, for patients (with a waiting list), who will receive the standardised information on ADs (usual care). Randomisation will be at the nurse level as each patient is referred to one of the 20 participating nurses (convenience sample of 20 nurses). A qualitative study will be conducted to understand the cognitive and emotional processes and experiences of nurses, patients and relatives confronted with end-of-life discussions. The outcome measurements include the completion of ADs (yes/no), anxiety, quality of communication about end-of-life care, empowerment, quality of life and attitudes towards ADs.Ethics and dissemination The study protocol has been approved by the Human Research Ethics Committee of the Canton of Geneva, Switzerland (no. 2019–00922). The findings will be disseminated to practice (nurses, patients and relatives), to national and international scientific conferences, and peer-reviewed journals covering nursing science, psychology and medicine.Trial registration number NCT04065685.

This article addresses the modalities of political inclusion in the Tropic of Cochabamba, a Bolivian rural coca-growing region, with a pacified social climate since Evo Morales took office in 2006. Nowadays, political inclusion depends on one economic activity, coca production, which is strictly controlled by unions. This economic corporativism is the product of the legacy of Agrarian Reform of 1953 and the politicization process of social organizations during the 1990s. This allowed unions to collect a number of symbolic, institutional and political resources and build a quasi-hegemonic political power in the Tropic. However, this territorial base generates significant political borders to inclusion. It also reveals some social tensions between the State and unions, usually invisible due to the persistent controversy surrounding coca production.

Abstract Background The screening of frail individuals at risk for functional health decline and adverse health outcomes lies in the evolving agenda of home care providers. Such a screening can be based on a frailty index (FI) derived from data collected with interRAI instruments used in clinical routines to define care plans. The objective of this study was to assess the feasibility of deriving an FI from the Resident Assessment Instrument – Home Care adapted for Switzerland (Swiss RAI-HC). Methods Data were collected by the Geneva Institution for Homecare and Assistance in clinical routines. The sample consisted of 3714 individuals aged 65 or older (67.7% females) who had each received a Swiss RAI-HC upon admission in the year of 2015. The FI was derived from 52 variables identified and scored according to published guidelines. Adverse health outcomes were either assessed during follow-up assessments (falls, hospitalizations) or documented from administrative records (mortality). Results The results showed that the FI was distributed normally, with a mean of 0.24 (± 0.13), an interquartile range of 0.16, and values of 0.04 at percentile 1 and 0.63 at percentile 99. The effect of Age was significant (R2 = 0.011) with a slope of β = 0.002, 95% CI = [0.001–0.002]. Sex as well as the Age × Sex interaction were not significant. The FI predicted deaths (OR = 9.99, 95% CI = [3.20–29.99]), hospitalizations (OR = 3.40, 95% CI = [1.78–6.32]), and falls (OR = 5.00, 95% CI = [2.68–9.38]). Conclusions The results support the feasibility of an FI derivation from the Swiss RAI-HC, hence replicating previous demonstrations based on interRAI instruments. The results also replicated findings showing that the FI is a good predictor of adverse health outcomes. Yet, the results suggest that home care recipients demonstrate a frailty pattern different from the one reported in community dwellers but comparable to clinical samples. Further work is needed to assess the characteristics of the proposed index in community-dwelling, non-clinical samples for comparability with the existing literature and external validation Trial registration ClinicalTrials.gov NCT03139162 . Retrospectively registered May 2, 2017.

Teleost fishes, thanks to their rapid evolution of sex determination mechanisms, provide remarkable opportunities to study the formation of sex chromosomes and the mechanisms driving the birth of new master sex determining (MSD) genes. However, the evolutionary interplay between the sex chromosomes and the MSD genes they harbor is rather unexplored. We characterized a male-specific duplicate of the anti-Müllerian hormone (amh) as the MSD gene in Northern Pike (Esox lucius), using genomic and expression evidence as well as by loss-of-function and gain-of-function experiments. Using RAD-Sequencing from a family panel, we identified Linkage Group (LG) 24 as the sex chromosome and positioned the sex locus in its sub-telomeric region. Furthermore, we demonstrated that this MSD originated from an ancient duplication of the autosomal amh gene, which was subsequently translocated to LG24. Using sex-specific pooled genome sequencing and a new male genome sequence assembled using Nanopore long reads, we also characterized the differentiation of the X and Y chromosomes, revealing a small male-specific insertion containing the MSD gene and a limited region with reduced recombination. Our study reveals an unexpectedly low level of differentiation between a pair of sex chromosomes harboring an old MSD gene in a wild teleost fish population, and highlights both the pivotal role of genes from the amh pathway in sex determination, as well as the importance of gene duplication as a mechanism driving the turnover of sex chromosomes in this clade.

Metric Multidimensional Scaling is commonly used to solve multi-sensor location problems in 2D or 3D spaces. In this paper, we show that such technique provides poor results in the case of indoor location problems based on 802.11 Fine Timing Measurements, because the number of anchors is small and the ranging error asymmetrically distributed. We then propose a two-step iterative approach based on geometric resolution of angle inaccuracies. The first step reduces the effect of poor ranging exchanges. The second step reconstructs the anchor positions, starting from the distances of highest likely-accuracy. We show that this geometric approach provides better location accuracy results than other Euclidean Distance Metric techniques based on Least Square Error logic. We also show that the proposed technique, with the input of one or more known location, can allow a set of fixed sensors to auto-determine their position on a floor plan.