Occurrence and outcomes of possible superadded infections in older adults with COVID-19-cohort study.

PURPOSE: Current guidance discourages use of antibiotics in COVID-19. However, in older adults, superadded infection may be common and require treatment. Our aim was to investigate the occurrence and outcomes from possible superadded infections, occurring within 2 weeks of hospitalization, in older adults with COVID-19. METHODS: This was a single centre, observational cohort study. We collected data from patients admitted to older adult wards who had tested positive for the Sars-CoV-2 virus on viral PCR between 1st October and 1st December 2020. The primary outcome was inpatient death occurring within 90 days of COVID-19 diagnosis. The secondary outcome was length of stay in hospital. Associations were described using univariable and multivariable models, and time to event data. RESULTS: Of 266 patients with COVID-19, 43% (115) had evidence of superadded infections (91 with positive bacterial cultures and 36 instances of radiological lobar consolidation). Patients with superadded infections were more likely to die (45.2 versus 30.7%, p = 0.020) and had an increased length of stay (23 versus 18 days, p = 0.026). CONCLUSIONS: Recommendations to avoid antibiotics in COVID-19 may not be applicable to an older adult population. Assessing for possible superadded infections is warranted in this group.

The care of older cancer patients in the United Kingdom.

The ageing population poses new challenges globally. Cancer care for older patients is one of these challenges, and it has a significant impact on societies. In the United Kingdom (UK), as the number of older cancer patients increases, the management of this group has become part of daily practice for most oncology teams in every geographical area. Older cancer patients are at a higher risk of both under- and over-treatment. Therefore, the assessment of a patient's biological age and effective organ functional reserve becomes paramount. This may then guide treatment decisions by better estimating a prognosis and the risk-to-benefit ratio of a given therapy to anticipate and mitigate against potential toxicities/difficulties. Moreover, older cancer patients are often affected by geriatric syndromes and other issues that impact their overall health, function and quality of life. Comprehensive geriatric assessments offer an opportunity to identify and address health problems which may then optimise one's fitness and well-being. Whilst it is widely accepted that older cancer patients may benefit from such an approach, resources are often scarce, and access to dedicated services and research remains limited to specific centres across the UK. The aim of this project is to map the current services and projects in the UK to learn from each other and shape the future direction of care of older patients with cancer.

The effects of visual degradation on face discrimination.

PURPOSE: People with reduced visual acuity (VA) and/or contrast sensitivity have difficulty recognizing faces and facial expressions. We have quantified these difficulties, using a synthetic face discrimination task employing both normal and artificially degraded vision. METHODS: VA and contrast thresholds were measured using an optimised staircase procedure [Freiburg acuity Test (FrACT)] in 25 young adults (aged 18-24 years) with corrected visual acuity of 0.0 logMAR or better and with four levels of vision degraded with Bangerter occlusion foils. For face discrimination, male face images were synthesised from 37 cardinal points (position of eyes, width of nose, head shape etc) derived from frontal face photographs and manipulated by altering the points as a fraction of the mean head radius. Face discrimination thresholds (% difference) were measured from a simultaneous four-alternative forced choice of 'odd one out' from three identical faces and one that differed. Psychometric functions were measured for four participants with normal and degraded vision. Subsequently, the difference between faces was fixed at twice the discrimination thresholds and the size of the faces manipulated using the FrACT threshold procedure in 25 participants. Data were converted to equivalent face discrimination distances for realistic face dimensions. RESULTS: With normal vision, face discrimination thresholds ranged from 2.7% to 5.6%; these increased systematically and were more variable with visual degradation. When manipulating face size, face discrimination distance was highly correlated with both acuity and contrast sensitivity (r(2) = 0.77 and 0.80 respectively, p < 0.01). The mean distance with normal vision was 15.3 m (14.5-16.2 ± S.E.M.). With vision degraded to 0.6 logMAR (6/24 Snellen, contrast threshold 15%) the mean face discrimination distance was reduced to 3.9 m (3.7-4.1, ±S.E.M.). CONCLUSIONS: Poor face discrimination has a profound impact on real-life social communication. Here we report that artificial visual degradation also adversely impacts a synthetic face recognition task. As a rule of thumb, reduction in VA of 0.3 logMAR (halving the decimal VA) reduces the face recognition distance by a factor of 0.6 times. The FrACT-based face discrimination task provides an efficient new tool to quantify and monitor face discrimination ability.