Introduction:Triage of patients is critical to patient safety, yet no clear information exists as to the utility of initial vital signs in identifying critically ill older emergency department (ED) patients. The objective of this study is to evaluate a set of initial vital sign thresholds as predictors of severe illness and injury among older adults presenting to the ED.Methods:We reviewed all visits by patients aged 75 and older seen during 2007 at an academic ED serving a large community of older adults. Patients’ charts were abstracted for demographic and clinical information including vital signs, via automated electronic methods. We used bivariate analysis to investigate the relationship between vital sign abnormalities and severe illness or injury, defined as intensive care unit (ICU) admission or ED death. In addition, we calculated likelihood ratios for normal and abnormal vital signs in predicting severe illness or injury.Results:4,873 visits by patients aged 75 and above were made to the ED during 2007, and of these 3,848 had a complete set of triage vital signs. For these elderly patients, the sensitivity and specificity of an abnormal vital sign taken at triage for predicting death or admission to an ICU were 73% (66,81) and 50% (48,52) respectively (positive likelihood ratio 1.47 (1.30,1.60); negative likelihood ratio 0.54 (0.30,0.60).Conclusion:Emergency provider assessment and triage scores that rely primarily on initial vital signs are likely to miss a substantial portion of critically ill older adults.

Whether initiation of statins could increase survival free of dementia and disability in adults aged ≥75 years is unknown. PREVENTABLE, a double‐blind, placebo‐controlled randomized pragmatic clinical trial, will compare high‐intensity statin therapy (atorvastatin 40 mg) with placebo in 20,000 community‐dwelling adults aged ≥75 years without cardiovascular disease, disability, or dementia at baseline. Exclusion criteria include statin use in the prior year or for >5 years and inability to take a statin. Potential participants are identified using computable phenotypes derived from the electronic health record and local referrals from the community. Participants will undergo baseline cognitive testing, with physical testing and a blinded lipid panel if feasible. Cognitive testing and disability screening will be conducted annually. Multiple data sources will be queried for cardiovascular events, dementia, and disability; survival is site‐reported and supplemented by a National Death Index search. The primary outcome is survival free of new dementia or persisting disability. Co‐secondary outcomes are a composite of cardiovascular death, hospitalization for unstable angina or myocardial infarction, heart failure, stroke, or coronary revascularization; and a composite of mild cognitive impairment or dementia. Ancillary studies will offer mechanistic insights into the effects of statins on key outcomes. Biorepository samples are obtained and stored for future study. These results will inform the benefit of statins for increasing survival free of dementia and disability among older adults. This is a pioneering pragmatic study testing important questions with low participant burden to align with the needs of the growing population of older adults.

ResumenSe estudió la mortalidad de 48 hembras adultas de Rhodnius robustus. Dada la significancia estadística del ajuste de los datos al modelo de Gompertz (p<0.0001), se puede afirmar que el mismo permite describir la mortalidad de esta especie. Abstract Mortality profile of 48 adult females of Rhodnius robustus shows that data analyzed by weeks and days have a statistical significantly fit (p<0.0001), that allows to affirm that mortality of this species is Gompertzian.

El propósito del presente trabajo es el estudio del ciclo biológico de R. robustus alimentado con sangre humana. Los triatominos procedían de una colonia fundada con ejemplares capturados en Caño Tigre, estado Mérida, Venezuela. Los insectos fueron alimentados a través de membrana de látex en un alimentador artificial a 37ºC con sangre humana con citrato de sodio como anticoagulante. Se observó una fecundidad de 13,9 huevos/hembra/semana, fertilidad 78,32 %, el ciclo biológico desde huevo a adulto se completó en aproximadamente 70 días. Los resultados muestran que R. robustus es capaz de reproducirse exitosamente al ser alimentada con sangre humana, lo cual contribuye a su potencialidad como especie domiciliaria y transmisora de la Enfermedad de Chagas.

We studied whether lower physical activity (PA) in older adults may partly explain the age-related decline in muscle mitochondrial function in the SOMMA cohort of 879 men and women, aged 70+. PA was measured both subjectively (CHAMPS questionnaire) and objectively (wrist-worn ActiGraph Link) classifying PA levels as sedentary, light, or moderate to vigorous (MVPA, ≥3 METS). Muscle mitochondrial function was assessed ex vivo via respirometry in permeabilized fiber bundles and as in vivo by 31Phosphorus magnetic resonance spectroscopy (31P-MRS) of the maximal rate of muscle ATP regeneration (ATPMAX in the quadriceps after contraction. Of 809 with respirometry or 31P-MRS, mean age was 76.4, 58.3% were women, 12.7% Black, 85.2% White and 2.1% other race/ethnicity. Mean OXPHOS and ATPMAX values were 1.91 pmol/(s*mg) and 0.016 mM/sec lower per 5-year age increment. Men self-reported more MVPA than women, but women recorded more MVPA with actigraphy. For both self-reported and recorded activity, associations with maximal tissue oxidative phosphorylation (OXPHOS) as well as ATPMAX were stronger for MVPA than for sedentary or light activity. After adjustment for age, sex, and clinic site, OXPHOS was lower for each standard deviation) fewer minutes/week of MVPA [reported, SD=408 min/wk: -3.66 pmol/(s*mg) (95% CI -4.93, -2.39); recorded, SD=600 min/wk: -1.93 pmol/(s*mg) (95% CI -3.31, -0.55)]. Similar associations were noted for ATPMAX. MVPA attenuated the association of age with mitochondrial function by 31–50% for both OXPHOS and ATPMAX, suggesting that MVPA could offset the lower mitochondrial function with age or that lower mitochondrial function impedes MVPA at older ages.