Syndromic thresholds based on NHS Direct data provide advance warning of influenza circulating in the community. We recommend that age-group specific thresholds be developed for other clinical influenza surveillance systems in the UK and elsewhere.

Fibrin microparticles were incorporated into poly(ethylene) glycol (PEG)-fibrinogen hydrogels to create an injectable, composite that could serve as a wound healing support and vehicle to deliver therapeutic factors for tissue engineering. Nitric oxide (NO), a therapeutic agent in wound healing, was loaded into fibrin microparticles by blending S-Nitroso-N-acetyl penicillamine (SNAP) with a fibrinogen solution. The incorporation of microparticles affected swelling behavior and improved tissue adhesivity of composite hydrogels. Controlled NO release was induced via photolytic and thermal activation, and modulated by weight percent of particles incorporated. These NO-releasing composites were non-cytotoxic in culture. Cells maintained morphology, viability, and proliferative character. Fibrin microparticles loaded with SNAP and incorporated into a PEG-fibrinogen matrix, creates a novel injectable composite hydrogel that offers improved tissue adhesivity and inducible NO-release for use as a regenerative support for wound healing and tissue engineering applications.

Objectives Loneliness is associated with increased risks of adverse health outcomes among middle-aged and older adults. We estimated the prevalence of loneliness and identified key sociodemographic, employment, living, and health-related risk factors for loneliness among adults aged ≥55 during the early phase of the COVID-19 pandemic in the United States, when much of the country was under shelter-in-place orders. Methods We collected data from online questionnaires in the COVID-19 Coping Study, a national study of 6938 US adults aged ≥55 from April 2 through May 31, 2020. We estimated the population-weighted prevalence of loneliness (scores ≥6 of 9 on the 3-item UCLA Loneliness Scale), overall and by sociodemographic, employment, living, and health-related factors. We used population-weighted modified Poisson regression models to estimate prevalence ratios (PRs) and 95% CIs for the associations between these factors and loneliness, adjusting for age, sex, race, ethnicity, and education level. Results Overall, we estimated that 29.5% (95% CI, 27.9%31.3%) of US adults aged ≥55 were considered high in loneliness in April and May 2020. In population-weighted adjusted models, loneliness was the most prevalent among those who reported depression, who were not married or in a relationship, who lived alone, and who were unemployed at the onset of the pandemic. Conclusions We identified subpopulations of middle-aged and older adults who were vulnerable to loneliness during a period when COVID-19 shelter-in-place orders were in place across most of the country. These insights may inform the allocation of resources to mitigate an unintended health consequence during times of restricted activity.

The comprehensive geriatric assessment (CGA) is the core tool used by geriatricians across diverse clinical settings to identify vulnerabilities and estimate physiologic reserve in older adults. In this paper, we demonstrate the iterative process at our institution to identify and develop a feasible, acceptable, and sustainable bedside CGA-based frailty index tool (FI-CGA) that not only quantifies and grades frailty but also provides a uniform way to efficiently communicate complex geriatric concepts such as reserve and vulnerability with other teams. We describe our incorporation of the FI-CGA into the electronic health record (EHR) and dissemination among clinical services. We demonstrate that an increasing number of patients have documented FI-CGA in their initial assessment from 2018 to 2020, while additional comanagement services were established (Figure 2). The acceptability and sustainability of the FI-CGA, and

Purpose We investigated the relationships between physical isolation at home during the period when many US states had shelter-in-place orders and subsequent longitudinal trajectories of depression, anxiety, and loneliness in older adults over a 6 month follow-up. Methods Data were from monthly online questionnaires with US adults aged ≥ 55 in the nation-wide COVID-19 Coping Study (April through October 2020, N = 3978). Physical isolation was defined as not leaving home except for essential purposes (0, 1-3, 4-6, and 7 days in the past week), measured at baseline (April-May). Outcomes were depressive symptoms (8-item Center for Epidemiological Studies Depression Scale), anxiety symptoms (5-item Beck Anxiety Inventory), and loneliness (3-item UCLA loneliness scale), measured monthly (April-October). Multivariable, population-and attritionweighted linear mixed-effects models assessed the relationships between baseline physical isolation with mental health symptoms at baseline and over time. Results Physical isolation (7 days versus 0 days in the past week) was associated with elevated depressive symptoms (adjusted β = 0.85; 95% CI 0.10-1.60), anxiety symptoms (adjusted β = 1.22; 95% CI 0.45-1.98), and loneliness (adjusted β = 1.06; 95% CI 0.51-1.61) at baseline, but not with meaningful rate of change in these mental health outcomes over time. The symptom burden of each mental health outcome increased with increasing past-week frequency of physical isolation. Conclusion During the early COVID-19 pandemic, physical isolation was associated with elevated depressive symptoms, anxiety symptoms, and loneliness, which persisted over time. These findings highlight the unique and persistent mental health risks of physical isolation at home under pandemic control measures.