BACKGROUND Clinical presentation and risk factors of death in COVID‐19 in oldest adults have not been well characterized. OBJECTIVES To describe clinical features and outcome of COVID‐19 in patients older than 85 years and study risk factors for mortality. DESIGN Prospective cohort. PARTICIPANTS AND SETTING Patients aged 85 years and older, admitted in noncritical care units at the University Hospital Lariboisière Fernand‐Widal (Paris, France) for confirmed severe acute respiratory syndrome coronavirus 2 infection were included and followed up for 21 days. MEASUREMENTS Clinical and laboratory findings were collected. Cox survival analysis was performed to explore factors associated with death. RESULTS From March 14 to April 11, 2020, 76 patients (median age = 90 (86–92) years; women = 55.3%) were admitted for confirmed COVID‐19. Of the patients, 64.5% presented with three or more comorbidities. Most common symptoms were asthenia (76.3%), fever (75.0%) and confusion and delirium (71.1%). An initial fall was reported in 25.0% of cases, and digestive symptoms were reported in 22.4% of cases. COVID‐19 was severe in 51.3% of cases, moderate in 32.9%, and mild in 15.8%. Complications included acute respiratory syndrome (28.9%), cardiac decompensation (14.5%), and hypotensive shock (9.0%). Fatality at 21 days was 28.9%, after a median course of disease of 13 (8–17) days. Males were overrepresented in nonsurvivors (68.2%). In survivors, median length of stay was 12 (9–19.5) days. Independent predictive factors of death were C‐reactive protein level at admission and lymphocyte count at nadir. CONCLUSION Specific clinical features, multiorgan injury, and high case fatality rate are observed in older adults with COVID‐19. However, rapid diagnosis, appropriate care, and monitoring seem to improve prognosis.

We consider the multi-trip vehicle routing problem, in which each vehicle can perform several routes during the same working shift to serve a set of customers. The problem arises when customers are close to each other or when their demands are large. A common approach consists of solving this problem by combining vehicle routing heuristics with bin packing routines in order to assign routes to vehicles. We compare this approach with a heuristic that makes use of specific operators designed to tackle the routing and the assignment aspects of the problem simultaneously. Two large neighborhood search heuristics are proposed to perform the comparison. We provide insights into the configuration of the proposed algorithms by analyzing the behavior of several of their components. In particular, we question the impact of the roulette wheel mechanism. We also observe that guiding the search with an objective function designed for the multi-trip case is crucial even when exploring the solution space of the vehicle routing problem. We provide several best known solutions for benchmark instances.

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A train of 150-fs 76-MHz pulses is directed into a Michelson interferometer with a path difference larger than the pulse spatial length. A modulated spectrum with a modulation frequency that increases with the path difference is observed. The consequence is discussed.

Background There is limited evidence on the characteristics and outcome of patients with dementia hospitalised for novel coronavirus infection (COVID-19). Method We conducted a prospective study in 2 gerontologic COVID units in Paris, France, from March 14, 2020, to May 7, 2020. Patients with dementia hospitalised for confirmed COVID-19 infection were systematically enrolled. A binary logistic regression analysis was performed to identify factors associated with mortality at 21 days. Results We included 125 patients. Median age was 86 (IQI 82–90); 59.4% were female. Most common causes of dementia were Alzheimer’s disease, mixed dementia and vascular dementia. 67.2% had ≥ 2 comorbidities; 40.2% lived in a long-term care facility. The most common symptoms at COVID-19 onset were confusion and delirium (82.4%), asthenia (76.8%) and fever (72.8%) before polypnea (51.2%) and desaturation (50.4%). Falls were frequent at the initial phase of the disease (35.2%). The fatality rate at 21 days was 22.4%. Chronic kidney disease and CRP at admission were independent factors of death. Persisting confusion, mood and behavioural disorders were observed in survivors (19.2%). Conclusion COVID-19 in demented individuals is associated with severe outcome in SARS-CoV-2 infection and is characterised by specific clinical features and complications, with confusion and delirium at the forefront. COVID-19 testing should be considered in front of any significant change from baseline.