Spectroscopic confirmation of a gravitationally lensed Lyman break galaxy at z[C II]= 6.827 using NOEMA

We present the spectroscopic confirmation of the brightest known gravitationally lensed Lyman break galaxy in the Epoch of Reionisation, A1703-zD1, through the detection of [C II]158 μm at a redshift of z = 6.8269 ± 0.0004. This source was selected behind the strong lensing cluster Abell 1703, with an intrinsic LUV∼L∗z=7 luminosity and a very blue Spitzer/IRAC [3.6]–[4.5] colour, implying high equivalent width line emission of [O III]+Hβ. [C II] is reliably detected at 6.1σ co-spatial with the rest-frame UV counterpart, showing similar spatial extent. Correcting for the lensing magnification, the [C II] luminosity in A1703-zD1 is broadly consistent with the local L[CII] – SFR relation. We find a clear velocity gradient of 103 ± 22 km s−1 across the source which possibly indicates rotation or an ongoing merger. We furthermore present spectral scans with no detected [C II] above 4.6σ in two unlensed Lyman break galaxies in the EGS-CANDELS field at z ∼ 6.6–6.9. This is the first time that NOEMA has been successfully used to observe [C II] in a ‘normal’ star-forming galaxy at z > 6, and our results demonstrate its capability to complement ALMA in confirming galaxies in the Epoch of Reionisation

Pharmacological Management of Anxiety Disorders in the Elderly

Anxiety disorders are common in the elderly. Additionally, anxiety symptoms often accompany co-morbid psychiatric, medical, as well as neurodegenerative diseases in the older population. Anxiety in the elderly, often accompanied by depression, can lead to worsening physical, cognitive and functional impairments in this vulnerable population. Antidepressants are considered first line treatment. Both SSRIs and SNRIs are efficacious and well-tolerated in the elderly. Some SSRIs are strong inhibitors of the cytochrome P450 hepatic pathway whereas others have less potential for drug interaction. Those antidepressants with more favorable pharmacokinetic profiles should be considered first-line in the treatment of anxiety. Mirtazapine and vortioxetine are also considered safe treatment options. Buspirone may have benefit, but lacks studies in elderly populations. Although tricyclic/tetracyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) may be effective in the elderly, their side effect and safety profiles are suboptimal and thus are not recommended in late-life. Benzodiazepines and beta blockers should generally be avoided when treating anxiety in the elderly. There is not enough evidence to support the use of antipsychotics or mood stabilizers given their risk of problems in both the long and short term. In addition, antipsychotics have a black box warning for increased mortality in elderly patients with dementia