Table_1_Technology obsolescence across the adult lifespan in a USA internet sample.DOCX

We know that older adults are less likely to own certain technological devices, such as smartphones, a technology now integral to telehealth. However, for those older adults who do own devices, we know very little about how their devices may differ from those of younger adults. The age of a device can determine the types of programs it can run, as well as the level of protection it has against malicious code. The following study is an attempt to understand the ages of devices owned by different demographic groups. An electronic survey was sent to American adults from ages 19–97, querying the types of devices they own, how old those devices are, when they plan on replacing them, and demographic information. Regression models were employed to determine the factors that predict device ownership and the age of the devices owned. We replicate the finding that older adults are less likely to own certain devices, like smartphones and laptops. However, they may be more likely to own more dated devices, such as non-smart mobile phones. Models of device age showed that older adults are more likely to own older smartphones, as well as older desktop and laptop computers. Thus, older adults may be more susceptible to hacking, due to obsolete technology. In some cases, they also may not have devices modern enough for technology-based health interventions. Thus, obsolete devices may present an additional barrier for adoption of technology-based interventions by older adults.</p

Post Brexit regional policy in England: exploring “levelling up” in practice

’Levelling Up’ has come to dominate debates around regional inequality in England but has been criticised for lacking clarity and definition. This paper addresses this critique by providing an early assessment of the concept. It summarises and critically reviews Levelling Up, arguing that the concept offers a mix of marginal and familiar policies, alongside aspirations for industrial policy and research and development. Furthermore, Levelling Up begins to diverge from recent policy in its spatial focus and approach to governance and devolution. As governments in Europe and the US grapple with similar challenges the paper has value beyond a UK audience.</p

Understanding resilient places: multi-level governance in times of crisis

When countries are impacted by a crisis, comparisons at the national level are often drawn. Whilst useful, this approach fails to explore how local measures are enacted alongside centralised responses. This paper addresses that gap by examining England’s intergovernmental response to the Covid-19 pandemic. With a focus on multi-level governance (MLG) and resilience theories the paper explores how tiers of government respond to the demands of the crisis. The focus is primarily on the responses of those involved with responding to the economic crisis with a recognition of the interlinked health and environmental crises. Adopting a case study approach, which included some of the areas hardest hit by the pandemic, the paper asks whether the application of MLG provided a resilient system to the shock of the pandemic. The findings illustrate local government sought to respond quickly, but decision-making was too often centrally controlled rather than devolved to the most appropriate scale. The paper draws lessons for how England might think constructively about its post pandemic reorientation considering the adaptation of intergovernmental roles and subnational governance that permits greater devolution to facilitate place-based recovery. Drawing on the knowledge gained throughout the pandemic, the paper argues that to Level Up in England and address the long-term economic and societal imbalances will demand a place-based recovery model.</p

Intergovernmental dynamics in responding to COVID-19 in English and Australian cities

This comparative study, conducted at the height of the COVID-19 pandemic, explores how the contrasting governance systems in Australia and England responded to complex and rapidly evolving problems presented by the crisis. Comparing how national and local governments worked together and alongside other forms of subnational governance, the findings highlight the efficacy of multiscalar governance arrangement in Australia over the fragmented, overly-centralised and inconsistent arrangements in England. As nations plan their recovery paths from the economic and social challenges of the crisis, the findings encourage a reset of spatial policy towards one that values and resources greater decentralisation and place-based recovery. </p

Intergovernmental dynamics in responding to COVID-19 in English and Australian cities

This comparative study, conducted at the height of the COVID-19 pandemic, explores how the contrasting governance systems in Australia and England responded to complex and rapidly evolving problems presented by the crisis. Comparing how national and local governments worked together and alongside other forms of subnational governance, the findings highlight the efficacy of multiscalar governance arrangement in Australia over the fragmented, overly-centralised and inconsistent arrangements in England. As nations plan their recovery paths from the economic and social challenges of the crisis, the findings encourage a reset of spatial policy towards one that values and resources greater decentralisation and place-based recovery. </p

Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled, phase 3 trial

Background Sparsentan, a novel, non-immunosuppressive, single-molecule, dual endothelin angiotensin receptor antagonist, significantly reduced proteinuria versus irbesartan, an angiotensin II receptor blocker, at 36 weeks (primary endpoint) in patients with immunoglobulin A nephropathy in the phase 3 PROTECT trial's previously reported interim analysis. Here, we report kidney function and outcomes over 110 weeks from the double-blind final analysis. Methods PROTECT, a double-blind, randomised, active-controlled, phase 3 study, was done across 134 clinical practice sites in 18 countries throughout the Americas, Asia, and Europe. Patients aged 18 years or older with biopsy-proven primary IgA nephropathy and proteinuria of at least 1·0 g per day despite maximised renin–angiotensin system inhibition for at least 12 weeks were randomly assigned (1:1) to receive sparsentan (target dose 400 mg oral sparsentan once daily) or irbesartan (target dose 300 mg oral irbesartan once daily) based on a permuted-block randomisation method. The primary endpoint was proteinuria change between treatment groups at 36 weeks. Secondary endpoints included rate of change (slope) of the estimated glomerular filtration rate (eGFR), changes in proteinuria, a composite of kidney failure (confirmed 40% eGFR reduction, end-stage kidney disease, or all-cause mortality), and safety and tolerability up to 110 weeks from randomisation. Secondary efficacy outcomes were assessed in the full analysis set and safety was assessed in the safety set, both of which were defined as all patients who were randomly assigned and received at least one dose of randomly assigned study drug. This trial is registered with ClinicalTrials.gov, NCT03762850. Findings Between Dec 20, 2018, and May 26, 2021, 203 patients were randomly assigned to the sparsentan group and 203 to the irbesartan group. One patient from each group did not receive the study drug and was excluded from the efficacy and safety analyses (282 [70%] of 404 included patients were male and 272 [67%] were White) . Patients in the sparsentan group had a slower rate of eGFR decline than those in the irbesartan group. eGFR chronic 2-year slope (weeks 6–110) was −2·7 mL/min per 1·73 m2 per year versus −3·8 mL/min per 1·73 m2 per year (difference 1·1 mL/min per 1·73 m2 per year, 95% CI 0·1 to 2·1; p=0·037); total 2-year slope (day 1–week 110) was −2·9 mL/min per 1·73 m2 per year versus −3·9 mL/min per 1·73 m2 per year (difference 1·0 mL/min per 1·73 m2 per year, 95% CI −0·03 to 1·94; p=0·058). The significant reduction in proteinuria at 36 weeks with sparsentan was maintained throughout the study period; at 110 weeks, proteinuria, as determined by the change from baseline in urine protein-to-creatinine ratio, was 40% lower in the sparsentan group than in the irbesartan group (−42·8%, 95% CI −49·8 to −35·0, with sparsentan versus −4·4%, −15·8 to 8·7, with irbesartan; geometric least-squares mean ratio 0·60, 95% CI 0·50 to 0·72). The composite kidney failure endpoint was reached by 18 (9%) of 202 patients in the sparsentan group versus 26 (13%) of 202 patients in the irbesartan group (relative risk 0·7, 95% CI 0·4 to 1·2). Treatment-emergent adverse events were well balanced between sparsentan and irbesartan, with no new safety signals. Interpretation Over 110 weeks, treatment with sparsentan versus maximally titrated irbesartan in patients with IgA nephropathy resulted in significant reductions in proteinuria and preservation of kidney function.</p