Recombinant SARS-CoV-2 RBD with a built in T helper epitope induces strong neutralization antibody response

Without approved vaccines and specific treatments, COVID-19 is spreading around the world with above 26 million cases and approximately 864 thousand deaths until now. An efficacious and affordable vaccine is urgently needed. The Val308 – Gly548 of spike protein of SARS-CoV-2 linked with Gln830 – Glu843 of Tetanus toxoid (TT peptide) (designated as S1-4) and without TT peptide (designated as S1-5) were expressed and renatured. The antigenicity and immunogenicity of S1-4 were evaluated by Western Blotting (WB) in vitro and immune responses in mice, respectively. The protective efficiency was measured preliminarily by microneutralization assay (MN50). The soluble S1-4 and S1-5 protein was prepared to high homogeneity and purity. Adjuvanted with Alum, S1-4 protein stimulated a strong antibody response in immunized mice and caused a major Th2-type cellular immunity supplemented with Th1-type immunity. Furthermore, the immunized sera could protect the Vero E6 cells from SARS-CoV-2 infection with neutralizing antibody titer 256. Recombinant SARS-CoV-2 RBD with a built in T helper epitope could stimulate both strong humoral immunity supplemented with cellular immunity in mice, demonstrating that it could be a promising subunit vaccine candidate.

Transcriptomic, Morphological, and Developmental Comparison of Adult Honey Bee Queens (Apis mellifera) Reared From Eggs or Worker Larvae of Differing Ages

Queens and workers are very distinct phenotypes that develop from the same genome. Larvae from worker cells up to 3.5 d old can be transferred to larger queen cells and will subsequently be reared as queens and develop into functional queens. This has become a very popular queen rearing practice in contemporary apiculture. Here we used RNA-Seq to study the consequences of rearing queens from transplanted worker larvae on the transcriptome of the adult queens. We found that queens reared from transferred older larvae developed slower, weighted less, and had fewer ovarioles than queens reared from transferred eggs, indicating queens were cryptically intercaste. RNA-Seq analysis revealed differentially expressed genes between queens reared from transferred larvae compared with queens reared from transferred eggs: the older the larvae transferred, the greater the number of differentially expressed genes. Many of the differentially expressed genes had functions related to reproduction, longevity, immunity, or metabolism, suggesting that the health and long-term viability of queens was compromised. Our finds verify the previous studies that adult queens reared from older transferred larvae were of lower quality than queens reared from transferred eggs or younger larvae.

Transgenerational accumulation of methylome changes discovered in commercially reared honey bee (Apis mellifera) queens

Whether a female honey bee (Apis mellifera) develops into a worker or a queen depends on her nutrition during development, which changes the epigenome to alter the developmental trajectory. Beekeepers typically exploit this developmental plasticity to produce queen bee by transplanting worker larvae into queen cells to be reared as queens, thus redirecting a worker developmental pathway to a queen developmental pathway. We studied the consequences of this manipulation for the queen phenotype and methylome over four generations. Queens reared from worker larvae consistently had fewer ovarioles than queens reared from eggs. Over four generations the methylomes of lines of queens reared from eggs and worker larvae diverged, accumulating increasing differences in exons of genes related to caste differentiation, growth and immunity. We discuss the consequences of these cryptic changes to the honey bee epigenome for the health and viability of honey bee stocks.

Effectiveness of remdesivir for the treatment of hospitalized COVID-19 persons: A network meta-analysis

Several randomized clinical trials (RCTs) that investigated the effectiveness of remdesivir for the treatment of coronavirus disease‐2019 (COVID‐19) have generated inconsistent evidence. The present study aimed to synthesize available RCT evidence using network meta‐analyses (NMAs). Both blinded and open‐label RCTs in PubMed database from inception to 7 June 2020 that contained “remdesivir”, “Covid‐19”, and “trial” in the abstracts conducted on hospitalized COVID‐19 persons were identified and screened. The studies must have at least one remdesivir arm and evaluated one of the pre‐specified outcomes. The outcomes were clinical improvement between days 10 to 15 after randomization and clinical recovery during the follow‐up period. The identified literature was supplemented with relatively recent studies that were known to the researchers if not already included. Frequentist NMAs with random effects were conducted. Both 10‐day and 5‐day remdesivir regimens were associated with higher odds of clinical improvement (odds ratio [OR] of 10‐day regimen: 1.35, 95% confidence interval [CI], 1.09‐1.67); OR of 5‐day regimen: 1.81, 95% CI, 1.32‐2.45, and higher probabilities of clinical recovery (relative risk [RR] of 10‐day regimen: 1.24, 95% CI, 1.07‐1.43; RR of 5‐day regimen: 1.47, 95% CI, 1.16‐1.87 compared with placebo. Remdesivir may have clinical benefits among hospitalized COVID‐19 persons.

Remdesivir has benefit of clinical improvement and clinical recovery among hospitalized Covid‐19 patients. Remdesivir may be recommended among hospitalized Covid‐19 patients. Evidence on mortality benefit and safety profiles of remdesivir is needed in future.

Estimating diet costs: Bridging the gap between food supply price databases and dietary intake data

Introduction

The cost of food is a key influence on diet. The majority of diet cost studies match intake data from population-based surveys to a single source of food supply prices such as the Consumer Price Index (CPI). Our aim was to examine the nutritional significance of using food supply data to price dietary intakes in Canada.

Methods

We examined food groups and nutrients in dietary intakes captured by the CPI. For prices, we used 2015 Canadian CPI average monthly item prices. For dietary intakes, we used reported intakes from the 2015 Canadian Community Health Survey (CCHS)-Nutrition, 1st 24-hour recall (n = 20,487). i) 2015 CPI item prices ($/g) were matched to the 156 food items from the 2015 CCHS-Nutrition as full, partial, or non-match; ii) CPI capture (full or partial match) per total intake (g), without water, was calculated for each respondent; iii) descriptive statistics and quantile regression (α = 0.05) were used to compare intakes of Canadian Nutrient File food groups and nutrients by quantile of CPI capture.

Results

The CPI captured on average 74% of total dietary intake (g) without water. A greater proportion of protein and fat intake was captured by the CPI as compared to carbohydrate, sodium, fibre, and sugar intake. Intakes of beef, poultry, sausages, pork, and breakfast foods had among the best match; snack foods, nuts, veal, and alcoholic beverages had among the worst. Individuals in the poorest CPI capture quantile consumed the greatest fibre (g), carbohydrates (g), total sugar (g), fat (g), protein (g), and energy (kcal) as compared to those with best CPI capture.

Conclusions

The poorest quantile of CPI capture reflects individuals with high intakes of nutrients of concern including fat, carbohydrates, and sugar; potential bias in estimating fibre and protein intake was also detected. Researchers and decision makers should attend to differential misclassification bias and opportunities for tailored datasets to price dietary intakes.

Key messages

Given the proliferation of diet cost studies using food supply prices, this novel study highlights the importance of understanding the biases in using food supply data to price dietary intakes. Nutrition researchers and decision makers can use these findings to strengthen food supply price data to support the monitoring of diet costs in relation to diet quality and health outcomes.

[Analysis on the cluster epidemic of coronavirus disease 2019 in Guangdong Province]

Objective: Analysis of clustering characteristics of coronavirus disease 2019 (COVID-19) in Guangdong Province. Methods: The COVID-19 cases in Guangdong Province onset from January 1 to February 29, 2020 were collected from Chinese information system for disease control and prevention and Emergency Public Reporting System. Obtain the epidemiological survey data of the cluster epidemic situation, and clarify the scale of cluster epidemic situation, the characteristics of the index cases, family and non-family subsequent cases. Calculate serial interval according to the onset time of the index cases and subsequent cases, secondary attack rate based on the close contacts tracking results, the characteristics of different cases in the clustered epidemic were compared. Results: A total of 283 cluster were collected, including 633 index cases, 239 subsequent cases. Families are mainly clustered, the total number involved in each cluster is in the range of 2-27, M (P₂₅, P₇₅) are 2.0 (2.0, 4.0). During January 15 to February 29, the secondary attack rate is 2.86% (239/8 363) in Guangdong Province, the family secondary attack rate was 4.84% (276/3 697), and the non-family secondary attack rate was 1.32% (61/4 632). According to the reporting trend of the number of cases in Guangdong Province, it can be divided into four stages, the rising stage, the high platform stage, the descending stage and the low level fluctuation period. The secondary attack rate of the four stages were 3.5% (140/3 987), 2.3% (55/2 399), 2.6% (37/1 435), 1.3% (7/542), respectively. The difference was statistically significant (P=0.003). Conclusion: COVID-19 cluster mainly occurs in families in Guangdong Province. The scale of the clustered epidemic was small; the serial interval was short; and the overall secondary attack rate was low.

Novel multiparameter correlates of Coxiella burnetii infection and vaccination identified by longitudinal deep immune profiling

Q-fever is a flu-like illness caused by Coxiella burnetii (Cb), a highly infectious intracellular bacterium. There is an unmet need for a safe and effective vaccine for Q-fever. Correlates of immune protection to Cb infection are limited. We proposed that analysis by longitudinal high dimensional immune (HDI) profiling using mass cytometry combined with other measures of vaccination and protection could be used to identify novel correlates of effective vaccination and control of Cb infection. Using a vaccine-challenge model in HLA-DR transgenic mice, we demonstrated significant alterations in circulating T-cell and innate immune populations that distinguished vaccinated from naïve mice within 10 days, and persisted until at least 35 days post-vaccination. Following challenge, vaccinated mice exhibited reduced bacterial burden and splenomegaly, along with distinct effector T-cell and monocyte profiles. Correlation of HDI data to serological and pathological measurements was performed. Our data indicate a Th1-biased response to Cb, consistent with previous reports, and identify Ly6C, CD73, and T-bet expression in T-cell, NK-cell, and monocytic populations as distinguishing features between vaccinated and naïve mice. This study refines the understanding of the integrated immune response to Cb vaccine and challenge, which can inform the assessment of candidate vaccines for Cb.

Parallel bimodal single-cell sequencing of transcriptome and chromatin accessibility

Joint profiling of transcriptome and chromatin accessibility within single cells allows for the deconstruction of the complex relationship between transcriptional states and upstream regulatory programs determining different cell fates. Here, we developed an automated method with high sensitivity, assay for single-cell transcriptome and accessibility regions (ASTAR-seq), for simultaneous measurement of whole-cell transcriptome and chromatin accessibility within the same single cell. To show the utility of ASTAR-seq, we profiled 384 mESCs under naive and primed pluripotent states as well as a two-cell like state, 424 human cells of various lineage origins (BJ, K562, JK1, and Jurkat), and 480 primary cord blood cells undergoing erythroblast differentiation. With the joint profiles, we configured the transcriptional and chromatin accessibility landscapes of discrete cell states, uncovered linked sets of cis-regulatory elements and target genes unique to each state, and constructed interactome and transcription factor (TF)–centered upstream regulatory networks for various cell states.

The biological characteristics of SARS-CoV-2 spike protein Pro330-Leu650

SARS-CoV-2 is the cause of the worldwide outbreak of COVID-19 that has been characterized as a pandemic by the WHO. Since the first report of COVID-19 on December 31, 2019, 179,111 cases were confirmed in 160 countries/regions with 7426 deaths as of March 17, 2020. However, there have been no vaccines approved in the world to date. In this study, we analyzed the biological characteristics of the SARS-CoV-2 Spike protein, Pro330-Leu650 (SARS-CoV-2-SPL), using biostatistical methods. SARS-CoV-2-SPL possesses a receptor-binding region (RBD) and important B (Ser438-Gln506, Thr553-Glu583, Gly404-Aps427, Thr345-Ala352, and Lys529-Lys535) and T (9 CD4 and 11 CD8 T cell antigenic determinants) cell epitopes. High homology in this region between SARS-CoV-2 and SARS-CoV amounted to 87.7%, after taking the biological similarity of the amino acids into account and eliminating the receptor-binding motif (RBM). The overall topology indicated that the complete structure of SARS-CoV-2-SPL was with RBM as the head, and RBD as the trunk and the tail region. SARS-CoV-2-SPL was found to have the potential to elicit effective B and T cell responses. Our findings may provide meaningful guidance for SARS-CoV-2 vaccine design.

Development of a novel hybrid method combining finite difference method and dissipative particle dynamics to simulate thrombus formation on orifice flow

In our previous works, the transport of activated platelets (APs) on orifice flow has been simulated by finite difference method (FDM). And the distribution of AP concentration on the flow was obtained. However, the effect of platelet aggregation on the distribution of AP concentration can't be investigated by FDM because FDM can't simulate platelet aggregation. On the other hand, platelet aggregation has been simulated by dissipative particle dynamics (DPD). In this paper, a hybrid method combining FDM and DPD is proposed to investigate the effect of platelet aggregation on the distribution of AP concentration. And the hybrid method is used to simulate thrombus formation on orifice flow. As for the effect of platelet aggregation, it is found that the distribution of AP concentration in the hybrid method is different from the distribution in FDM at the places of platelet aggregation. It is considered that the difference is induced by platelet aggregation. As for the distribution of thrombus, higher AP concentration and more aggregated APs are found around the reattachment point and in the recirculation area. It is considered that thrombus is mainly distributed at these places in the simulation. And according to our previous experimental results, thrombus is mainly distributed around the reattachment point and in the recirculation area. It is concluded that the effect of platelet aggregation on the distribution of AP concentration can be investigated by the hybrid method, and the computational results agree with our previous experimental results.

20-Hydroxyecdysone receptor-activated Bombyx mori CCAAT/enhancer-binding protein gamma regulates the expression of BmCBP and subsequent histone H3 lysine 27 acetylation in Bo. mori

Cyclic adenosine monophosphate (cAMP) response element binding protein (CREB)-binding protein (CBP or CREBBP) plays important roles in regulating gene transcription and animal development. However, the process by which CBP is up-regulated to impact insect development is unknown. In this study, the regulatory mechanism of Bombyx mori CBP (BmCBP) expression induced by 20-hydroxyecdysone (20E) was investigated. In the Bo. mori cell line, DZNU-Bm-12, 20E enhanced BmCBP transcription and histone H3K27 acetylation. BmCBP RNA interference (RNAi) resulted in decreased histone H3K27 acetylation. Additionally, the luciferase activity analysis revealed that the transcription factor, Bo. mori CCAAT/enhancer-binding protein gamma (BmC/EBPg), activated BmCBP transcription, which was suppressed by BmC/EBPg RNAi and promoted by BmC/EBPg overexpression. Electrophoretic mobility shift assay and chromatin immunoprecipitation results demonstrated that BmC/EBPg could bind to the C/EBP cis-regulatory elements in two positions of the BmCBP promoter. Moreover, BmC/EBPg transcription was enhanced by the 20E receptor (BmEcR), which bound to the BmC/EBPg promoter. BmEcR RNAi significantly inhibited the transcriptional levels of BmC/EBPg and BmCBP in the presence of 20E. Furthermore, the BmEcR-BmC/EBPg pathway regulated the acetylation levels of histone H3K27. Altogether, these results indicate that BmEcR enhances the expression of BmC/EBPg, which binds to the BmCBP promoter, activates BmCBP expression and leads to histone H3K27 acetylation.

Adaptation of plants to high-calcium content kart regions: possible involvement of symbiotic microorganisms and underlying mechanisms

Rhizosphere microorganisms and endophytes can help their hosts absorb nutrients and regulate the levels of plant hormones. Moreover, they can modulate the expressions of host genes, assist hosts in eliminating reactive oxygen species (ROS) and secreting volatile organic compounds. Therefore, rhizosphere microorganisms and endophytes are considered as determinant factors driving processes involved in the growth of host plants. However, the physiological and ecological functions, as well as the molecular mechanism underlying the behavior of rhizosphere microorganisms and endophytes in their role in the adaptive capacity of host plants in the karstic high-calcium environment have not been systematically studied. This review summarizes the physiological and molecular mechanisms of rhizosphere microorganisms and endophytes which help host plants to adapt to various kinds of adverse environments. The adaptive capacities of plants growing in adverse environments, partly, or totally, depends on microorganisms co-existing with the host plants.

Watershed, climate, and stable isotope data (oxygen-18 and deuterium) for 50 boreal lakes in the oil sands region, northeastern Alberta, Canada, 2002-2017

Watershed data, climate and stable data collected over a 16-year period from a network of 50 lakes in northeastern Alberta, are provided to allow for broader incorporation into regional assessments of environmental impacts, particularly hydrologic and geochemical processes under changing climate and land use development. Oxygen-18 and deuterium analyses of water samples are provided from late summer surveys of 50 lakes with varying land cover and permafrost conditions. Six sub-groups of lakes are represented, including Stony Mountains, West Fort McMurray, Northeast Fort McMurray, Birch Mountains, Caribou Mountains and Shield. This dataset includes 1582 isotopic analyses made on 791 water samples and 3164 isotope mass balance model outputs, as well as 800 lake/watershed parameters, 5600 climate parameters, and 800 modelled values for isotopic composition of precipitation used in the computations. Model data are provided to facilitate evaluation of transferability of the model for other applications, and to permit more sophisticated spatial analysis and intercomparison with geochemical and biological datasets. Details and further discussion on the isotope mass balance approach are provided in “Regional trends in water balance and runoff to fifty boreal lakes: a 16-year isotope mass balance assessment including evaluation of hydrologic drivers” [1]. Overall, the data are expected to be useful, in comparison with local and regional datasets, for water resource management and planning, including design of monitoring networks and environmental impact assessments for oil sands projects.

Chloroquine pretreatment attenuates ischemia-reperfusion injury in the brain of ob/ob diabetic mice as well as wildtype mice

Chloroquine, a prototype anti-malaria drug, has been reported to possess anti-inflammatory effects. Moreover, chloroquine pretreatment could improve DNA damage repair. It is therefore reasonable to hypothesize that chloroquine pretreatment could attenuate ischemia/reperfusion injury in the brain. Considering the fact that chloroquine could also improve glucose metabolism, we speculated that the potential effects of chloroquine on ischemia/reperfusion injury might be particularly pronounced in diabetic mice. In this study, chloroquine pretreatment protected neurons from Oxygen Glucose Deprivation (OGD) induced cytotoxicity and apoptosis. In vivo, Ob/ob mice and wildtype (WT) mice were pretreated with chloroquine for 3 weeks. Then, ischemic stroke was induced by 60 min Middle Cerebral Artery Occlusion (MCAO). We found that chloroquine pretreatment normalized blood glucose in diabetic ob/ob mice, and reduced cerebral damage after ischemic stroke especially for diabetic mice. In addition, chloroquine pretreatment reduced High-mobility group box 1 (HMGB1) content in the cerebrospinal fluid (CSF) and serum and lowered myeloperoxidase (MPO) activity and inflammatory cytokines gene expression both in the ob/ob diabetic mice and WT mice. Moreover, harmful DNA damage-signaling responses, including PARP activation and p53 activation, were also attenuated by chloroquine pretreatment in these two kinds of mice. In conclusion, chloroquine pretreatment could reduce cerebral damage after ischemic stroke especially in diabetic mice through multiple mechanisms, which include reducing neural cell DNA injury, restoring euglycemia and anti-inflammatory effects. The findings may provide potential for the development of chloroquine in the prevention and treatment of stroke in diabetic high-risk patients.

Re-entering the pluripotent state from blood lineage: promises and pitfalls of blood reprogramming

Blood reprogramming, in which induced pluripotent stem cells (iPSCs) are derived from haematopoietic lineages, has rapidly advanced over the past decade. Since the first report using human blood, haematopoietic cell types from various sources, such as the peripheral bone marrow and cord blood, have been successfully reprogrammed. The volume of blood required has also decreased, from around tens of millilitres to a single finger-prick drop. Besides, while early studies were limited to reprogramming methods relying on viral integration, nonintegrating reprogramming systems for blood lineages have been subsequently established. Together, these improvements have made feasible the future clinical applications of blood-derived iPSCs. Here, we review the progress in blood reprogramming from various perspectives, including the starting materials and subsequent reprogramming strategies. We also discuss the downstream applications of blood-derived iPSCs, highlighting their clinical value in terms of disease modelling and therapeutic development.

Effect of age at menarche on microvascular complications among women with Type 1 diabetes

AIM

To test the hypothesis that delayed menarche is associated with an increased microvascular complication risk among women with Type 1 diabetes.

METHODS

We studied the female participants of an ongoing prospective study of childhood-onset Type 1 diabetes diagnosed during the period 1950-1980. Of 325 women, we included data from 315 who had reached menarche by the study baseline (1986-1988) and who self-reported their age at menarche. Both cross-sectional and prospective analyses over the 25-year follow-up were used to assess the relationship of age at menarche with the prevalence, incidence and cumulative incidence of microvascular complications, comprising overt nephropathy, proliferative retinopathy and confirmed distal symmetric polyneuropathy.

RESULTS

In cross-sectional analyses at baseline, the odds of overt nephropathy increased 1.24 times (P=0.02) with each annual increase in age at menarche, and 3.2 times (P=0.009) in those with delayed menarche compared with women with normal menarche onset, after adjustment. Similarly, the cumulative incidence of overt nephropathy increased 1.16 times (P=0.01) with each older year of menarche and women with delayed menarche were at twofold increased risk of overt nephropathy (hazard ratio 2.30, P=0.001) compared with women with normal menarche onset. However, age at menarche was not significantly associated with either proliferative retinopathy or confirmed distal symmetric polyneuropathy after adjusting for covariates.

CONCLUSIONS

Age at menarche was significantly associated with the prevalence and cumulative incidence of overt nephropathy, but not with proliferative retinopathy or confirmed distal symmetric polyneuropathy in Type 1 diabetes. Women with delayed menarche may therefore be targeted for early screening and timely interventions to prevent the development of nephropathy.

Intranasal Immunization Using CTA1-DD as a Mucosal Adjuvant for an Inactivated Influenza Vaccine

OBJECTIVE

To evaluate the effect of intranasal immunization with CTA1-DD as mucosal adjuvant combined with H3N2 split vaccine.

METHODS

Mice were immunized intranasally with PBS (negative control), or H3N2 split vaccine (3 μg/mouse) alone, or CTA1-DD (5 μg/mouse) alone, or H3N2 split vaccine (3 μg/mouse) plus CTA1-DD (5 μg/mouse). Positive control mice were immunized intramuscularly with H3N2 split vaccine (3 μg/mouse) and alum adjuvant. All the mice were immunized twice, two weeks apart. Then sera and mucosal lavages were collected. The specific HI titers, IgM, IgG, IgA, and IgG subtypes were examined by ELISA. IFN-γ and IL-4 were test by ELISpot. In addition, two weeks after the last immunization, surivival after H3N2 virus lethal challenge was measured.

RESULTS

H3N2 split vaccine formulated with CTA1-DD could elicit higher IgM, IgG and hemagglutination inhibition titers in sera. Furthermore, using CTA1-DD as adjuvant significantly improved mucosal secretory IgA titers in bronchoalveolar lavages and vaginal lavages. Meanwhile this mucosal adjuvant could enhance Th-1-type responses and induce protective hemagglutination inhibition titers. Notably, the addition of CTA1-DD to split vaccine provided 100% protection against lethal infection by the H3N2 virus.

CONCLUSION

CTA1-DD could promote mucosal, humoral and cell-mediated immune responses, which supports the further development of CTA1-DD as a mucosal adjuvant for mucosal vaccines.

[Health-related quality of life and health-adjusted life expectancy among patients with chronic non-communicable diseases, in Guangdong province]

Objective: To estimate the health-related quality of life (HRQOL) and health-adjusted life expectancy (HALE) which were associated with chronic non-communicable diseases (NCDs) in people from Guangdong province of China. Methods: Data on both NCDs prevalence and EuroQol-5 Dimensions-3 Levels measured HRQOL were gathered from the Fifth National Health Survey in Guangdong province, 2013. Logistic regression model and multiple linear regression model were employed to explore the impact of NCDs on HRQOL. Life expectancy (LE) and HALE were used to evaluate the comprehensive impact of chronic diseases on population health. Results: A total of 68 550 inhabitants were included in the analysis. Graded logistic regression showed that the impact of chronic diseases on all dimensions of quality of life was statistically significant after adjusting for social demographic characteristics. The greatest health impact was on the pain/discomfort health dimension [OR=4.48 (95%CI:4.20-4.77)], followed by anxiety/depression[OR=3.95 (95%CI: 3.62- 4.31)], daily activities [OR=3.69 (95%CI: 3.37-4.04)], mobility [OR=3.63 (95%CI: 3.34-3.94)]and ability on self-care [OR=3.30 (95%CI: 2.98-3.66)]. Losses of LE and HALE caused by NCDs were 12.7 and 14.6 years respectively while the overall expected gain was 3.8 years in HALE, when NCDs were taken away. Conclusions: Our data showed that NCDs had shortened the healthy life span of patients through reducing the HRQOL and also causing heavy disease burden on both patients with NCDs and the communities. Health-care related policies on NCDs need to be developed, for the elderly, in particular.