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Shallow, tropical marine ecosystems provide essential ecosystem goods and services, but it is unknown how these ecosystems will respond to the increased exposure to the temperature extremes that are likely to become more common as climate change progresses. To address this issue, we tracked the fitness and productivity of a key zooplankton species, the copepod Pseudodiaptomus annandalei , acclimated at two temperatures (30 and 34 °C) over three generations. 30 °C is the mean temperature in the shallow water of the coastal regions in Southeast Asia, while 34 °C simulated a temperature extreme that occurs frequently during the summer period. For each generation, we measured the size at maturity and reproductive success of individuals. In all three generations, we found strong negative effects of warming on all measured fitness-related parameters, including prolonged development time, reduced size at maturity, smaller clutch sizes, lower hatching success, and reduced naupliar production. Our results suggest that P . annandalei are already exposed to temperatures that exceed their upper thermal optimum. Increased exposure to extreme temperatures may reduce the abundance of these tropical marine copepods, and thus reduce the availability of resources to higher trophic levels.

Marine heatwaves (MHWs) are emerging as a severe stressor in marine ecosystems. Extreme warm sea surface temperatures during MHWs often exceed the optimal thermal range for more than one generation of tropical coastal zooplankton. However, it is relatively unknown whether transgenerational plasticity (TGP) to MHWs may shape the offspring's fitness, particularly in an ecologically relevant context with biotic interactions such as predation stress. We addressed these novel research questions by determining the survival, reproductive success, and grazing rate of the copepod Pseudodiaptomus incisus exposed to MHW and fish predator cues (FPC) for two generations (F1 and F2). The experiment was designed in a full orthogonal manner with 4 treatments in F1 and 16 treatments in F2 generation. In both generations, MHW reduced P. incisus survival, reproductive parameters, and grazing by 10%–62% in MHW, but these parameters increased by 2%–15% with exposure to FPC, particularly at control temperature. F2 reproductive success and grazing rate as indicated by cumulative fecal pellets were reduced by 20%–30% in F1‐MHW, but increased by ~2% in F1‐FPC. Strikingly, MHW exposure reduced 17%–18% survival, but transgenerational exposure to MHWs fully ameliorated its lethal effect and this transgenerational effect was independent of FPC. Increased survival came with a cost of reduced reproductive success, constrained by reduced grazing. The rapid transgenerational MHW acclimation and its associated costs are likely widespread and crucial mechanisms underlying the resilience of coastal tropical zooplankton to MHWs in tropical coastal marine ecosystems. Marine heatwaves emerge as a severe stressor in marine ecosystems, yet it is relatively unknown whether transgenerational effect of marine heatwaves may shape the offspring fitness, particularly in an ecologically relevant context with biotic interactions such as predation stress. Our study showed that transgenerational exposure to marine heatwaves fully ameliorated its lethal effect on tropical copepod Pseudiaptomus incisus with a cost of reduced reproductive success constrained by the lowered grazing. Fish predation stress played a minor role in shaping the copepod performance, both within and across generations with or without marine heatwaves.

Background Spontaneous walking speed (SWS) is one of the most important indicators of health in older adults. Studies have shown benefits of physical trainings on SWS in older adults but the impact of cognitive training and multidomain interventions remains understudied. Aims This original study aimed at comparing the impact of aerobic/resistance exercise, computerized cognitive training and the combination of both interventions compared with active control conditions on SWS in healthy older adults. Methods Ninety community-dwelling older adults were randomly assigned to four different combinations composed of two active interventions: physical aerobic/resistance and cognitive dual-task trainings, and two active control conditions: stretching exercises and computer lessons. The four combinations were the following: (1) aerobic/resistance and cognitive dual task ( n  = 28), (2) aerobic/resistance and computer lessons ( n  = 21), (3) stretching exercises and cognitive dual task and ( n  = 23), (4) stretching exercises and computer lessons ( n  = 18). Training sessions were held three times/week for three months. SWS for 30 s was assessed before and after the intervention. Results Repeated-measures ANOVA showed a main effect of time and a significant three-way interaction suggesting differential improvement in SWS according to training combinations. A clinical meaningful improvement in SWS was observed in groups 1–3 (0.08–0.14 m/s; effect sizes: small to moderate) but not in the active control group 4. Discussion Results of this study suggest that aerobic/resistance exercise and computerized dual-task training are two non-pharmacological interventions by which SWS, a functional vital sign, can be clinically improved in older adults. Conclusion This original study pointed out different tools to prevent functional decline in older people.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Background: Emergency department (ED) visits are critical events for older adults, but little is known regarding their experiences, particularly about their physical needs, the involvement of accompanying family members, and the transition back to the community. Objective: To explore experiences of an ED visit among patients aged 75 and older. Methods: In a mixed-methods study, a cohort of patients aged 75 and older (or a family member) discharged from the ED back to the community was recruited from 4 urban EDs. A week following discharge, structured telephone interviews supplemented with open-ended questions were conducted. A subsample (76 patients, 32 family members) was purposefully selected. Verbatim transcripts of responses to the open-ended questions were thematically analyzed. Results: Experiences related to physical needs included comfort, equipment supporting mobility and autonomy, help when needed, and access to drink and food. Family members required opportunities to provide patient support and greater involvement in their care. At discharge, patients/families required adequate discharge education, resolution of their health problem, information on medications, and greater certainty about planned follow-up medical and home care services. Conclusions: Our findings suggest several areas that could be targeted to improve patient and family perceptions of the care at an ED visit.

Diabetic peripheral neuropathy is characterized by mitochondrial dysfunction, including suboptimal respiration, impaired calcium homeostasis, and accumulation of reactive oxygen species (ROS). Hyperglycemia drives excessive electron donation to the mitochondria, resulting in damaging ROS levels. In peripheral neurons, hyperglycemia also leads to the formation of advanced glycation end-products (AGEs), which, through their membrane receptor (RAGE), trigger autonomic malfunction in diabetes. However, it remains unclear whether RAGE is required to induce mitochondrial abnormalities under hyperglycemia. Thus, we first investigated mitochondrial morphology in autonomic ganglia (superior cervical ganglion, SCG) from streptozotocin (STZ)-induced diabetic mice and found an enhanced proportion of swollen mitochondria with disrupted cristae in wild-type (WT) diabetic mice, but not in RAGE knock-out (KO) diabetic mice. Next, we exposed cultured SCG neurons to high glucose and found fragmentation and an imbalanced traffic represented by an increased proportion of only anterograde moving mitochondria in neurons from WT, but such imbalance was not observed in neurons from RAGE KO mice. Treating WT neurons with the non-membrane permeable RAGE selective inhibitor FPS-ZM1, did not prevent fragmentation, although a non-significant restoring trend was observed. Furthermore, ATP production was unaffected by exposure to high glucose in neurons for WT, and remained unchanged by incubation in FPS-ZM1. Interestingly, neurons from RAGE KO mice had significantly less ATP produced in all conditions than those from WT mice. Lastly, we found RAGE protein in enriched mitochondrial fractions from nerve growth factor (NGF)-transformed PC12 (PC12 NGF ) cells, as well as the colocalization of RAGE with a mitochondrial marker in cultured SCG neurons. Therefore, our data support that RAGE mediates mitochondrial damage in autonomic neurons under hyperglycemic conditions.

Background Delirium is a significant cause of morbidity and mortality among older people admitted to both acute and long-term care facilities (LTCFs). Multicomponent interventions have been shown to reduce delirium incidence in the acute care setting (30–73%) by acting on modifiable risk factors. Little work, however, has focused on using this approach to reduce delirium incidence in LTCFs. Methods The objective is to assess the effectiveness of the multicomponent PREPARED Trial intervention in reducing the following primary outcomes: incidence, severity, duration, and frequency of delirium episodes in cognitively impaired residents. This 4-year, parallel-design, cluster randomized study will involve nursing staff and residents in 45–50 LTCFs in Montreal, Canada. Participating public and private LTCFs (clusters) that provide 24-h nursing care will be assigned to either the PREPARED Trial intervention or the control (usual care) arm of the study using a covariate constrained randomization procedure. Approximately 400–600 LTC residents aged 65 and older with dementia and/or cognitive impairment will be enrolled in the study and followed for 18 weeks. Residents must be at risk of delirium, delirium-free at baseline and have resided at the facility for at least 2 weeks. Residents who are unable to communicate verbally, have a history of specific psychiatric conditions, or are receiving end-of-life care will be excluded. The PREPARED Trial intervention consists of four main components: a decision tree, an instruction manual, a training package, and a toolkit. Primary study outcomes will be assessed weekly. Functional autonomy and cognitive levels will be assessed at the beginning and end of follow-up, while information pertaining to modifiable delirium risk factors, medical consultations, and facility transfers will be collected retrospectively for the duration of the follow-up period. Primary outcomes will be reported at the level of intervention assignment. All researchers analyzing the data will be blinded to group allocation. Discussion This large-scale intervention study will contribute significantly to the development of evidence-based clinical guidelines for delirium prevention in this frail elderly population, as it will be the first to evaluate the efficacy of a multicomponent delirium prevention program translated into LTC clinical practice on a large scale. Trial registration NCT03718156 , ClinicalTrials.gov .

Understanding and optimising the parameters that controls the success for copepod cultures are the foundation for large scaled copepod cultures. Many underlying copepod culture parameters are already quantified and comprehended, but there is a lack in knowledge of optimising feeding regimes for copepod cultures. In the present study, quantification and observations on how three different feeding regimes affected Acartia tonsa cultures, in terms of development time, specific growth rate, egg production, and egg hatching success were done. The three feeding regimes where dispensed as; once a day (spiked feeding), in four equal pulses (pulsed feeding), and evenly over 24 h (continuous feeding). The feeding regimes were investigated at low food levels (~200 µg C L −1 ) and at full-saturated food levels (~1800 µg C L −1 ). As photoperiod may have an effect on feeding uptake and productivity, the present experiments were segregated into two light regimes, one in darkness (0 L :24 D ) and one in light (24 L :0 D ). Acartia tonsa exposed to fully saturate feed levels developed twice as fast as at low saturated feed levels. A significantly higher total egg production from copepods was observed, equal to 53.5 % more eggs produced in dark cultures. Also, a 2.3 % significantly higher egg hatching success was obtained when culturing in dark. Since feeding regimes do not affect cultures, it is recommended that feeding of A. tonsa should be conducted as practical as possible for the individual copepod farmer, since optimal performance will be met as long as feed is supplied in excess. Furthermore, it is recommended that cultures are kept in dark for optimal egg production and sub sequent hatching success.

Severe tricuspid regurgitation remains largely undertreated given limited treatment options. Transcatheter tricuspid valve interventions have emerged as a promising therapy for these patients, and the TRISCEND II pivotal trial is the first randomized controlled trial to evaluate transcatheter tricuspid valve replacement (TTVR). The TRISCEND II pivotal trial studies the transcatheter EVOQUE (Edwards Lifesciences, Irvine, California) tricuspid valve replacement system using a United States Food and Drug Administration Breakthrough Device Designation—a program intended to provide timely access to medical devices by speeding up development, assessment, and review. The TRISCEND II trial is a prospective, multicenter trial that randomizes patients with symptomatic severe tricuspid regurgitation to treatment with either TTVR in conjunction with optimal medical therapy or optimal medical therapy alone. The trial's novel 2-phase design evaluates 30-day safety and 6-month effectiveness end points for the first 150 patients in the initial phase and a 1-year safety and effectiveness end point for the full cohort of 400 patients in the second phase. The TRISCEND II trial's 2-phase trial design provided an opportunity for early review and led to the first commercial approval of a TTVR system. In conclusion, the design of the TRISCEND II trial will likely inform future transcatheter tricuspid device trials.

In some settings, rotavirus vaccines have been associated with a low-level risk of intussusception, the most common cause of bowel obstruction in infants. As Vietnam prepares to introduce rotavirus vaccine into the national immunization program, we sought to better characterize the epidemiology of recurrent intussusception. We enrolled children <2 years of age who were hospitalized for intussusception retrospectively from January 2013 through December 2014 and prospectively from January 2015 through December 2016 at 2 hospitals in Vietnam. We enrolled 2477 children. Nearly all children were successfully treated by enema with low surgery rate (1%). We found 10% of children (n = 254) experienced at least once recurrence (range: 1–6) and 57% of first recurrences happened within the first 12 weeks after treatment of the first episode. The median age at first intussusception was 13 months for children without a recurrent episode and 10 months for children with a recurrence. The symptoms of the recurrent cases were milder with less vomiting (67%), bloody stool (7%) and fever (10%) compared to the initial cases (p < 0.01). We found the rate of recurrences following enema reduction of intussusception to be similar to that reported from other countries. Due to the high rate of intussusception and recurrent episodes in Vietnam, a better understanding of the cause of recurrent intussusception will be critical in assessing intussusception cases after rotavirus introduction.