identifying the most at risk older people in Emergency Departments (EDs) may help guide clinical practice, and service improvement in emergency care, but little is known about how to implement such ...tools in practice.
consensus building was used to determine the desirable characteristics of a risk stratification process, including focus groups and literature reviewing. Candidate tools were tested using clinical vignettes in semi-structured interviews with a range of clinicians working in one large ED, assessing speed of use, ease of use and agreement with clinical judgement. The primary outcome was the likelihood of future use of a given frailty tool.
the ideal tool characteristics included brevity (<1 min), simplicity and multidimensionality; tools selected for testing included the Identification of Seniors At Risk, Clinical Frailty Scale, PRISMA-7 and Silver Code. One hundred and twenty-one staff members (43% of the total ED workforce) were recruited from one large ED in the East Midlands. Two hundred and thirty-six individual frailty tool assessments were undertaken using 1 of 10 clinical vignettes; 75% of staff stated that they would use at least one of the tools again, with no significant differences between the individual tools. The median time to complete the tool was around 1 min per patient for all four tools. There were no significant differences in timing, ease of use or agreement with clinical judgement between tools.
validated risk stratification tools are quick, simple, easy to use and 75% of staff would use the tools again in the future.
To explore the lived experiences of prediabetic participants in an in-home, family-based meal kit delivery intervention for 12 weeks. Delivered foods followed a plant-dominant pattern, including ...small meat portions, to encourage long-term adoption of this pattern.
Qualitative in-depth individual interviews (n = 21) were undertaken online with 7 pilot participants, at 3-time points (preintervention, during intervention, and postintervention). Three online focus groups were also undertaken postintervention with 12 participants.
Postintervention, most participants reported positive changes in eating patterns and mindset changes enabling future healthier eating. The deliveries inspired enthusiasm for tastier cooking and family involvement. Although participants indicated they felt well-being improvements, they often became focused on the outcome of their physical test results (eg, weight), leading to some disappointment and feelings of failure.
Participant engagement with the intervention was high, but other underlying emotions, outside diet behavior, can affect long-term adoption outcomes. This has implications for designing future interventions.
Cultured foods have the potential to profoundly transform the food industry. However, most current research focuses on cultured meat, neglecting other cultured products and begging the question of ...whether different promotional approaches are suited for certain types of cultured food products than others. To bridge this knowledge gap, we carried out two studies to explore how product type (cultured meat vs. cultured fruit) and benefit type (ethical vs. product attributes such as sensory and nutritional advantages) interact in determining consumers' willingness to try the products. Study 1 findings indicate that emphasizing ethical benefits is more effective for promoting cultured meat, whereas highlighting product benefits is more effective for promoting cultured fruit. We found that curiosity, a strong behavioral motivator, mediates the interactive effect of product type and benefit type on willingness to try. This research underscores the need for marketing messages to be tailored to the distinct cultured product types and enriches the literature on curiosity as an important mechanism in the context of cultured food acceptance.
Food consumption is being reconfigured as a consequence of consumers’ ethical concerns. While preferences and tastes may be influenced by broad ethical positions, constructions of social identity ...also reflect shifts in food consumption. Important tools within this nexus are ‘future foods’, produced through novel technologies such as artificial intelligence or genetic editing, supporting consumers in the construction of identity markers. Through 24 (n = 121) focus groups in rural and urban Australia, we explore to what extent future foods contribute to alleviate tensions between broader ethical principles and consumer identities. We argue that the collective discourse around future foods has the potential to shift the culture of food ethics in the future, enabled through three moral identity markers. Specifically, identities of citizen-consumption that view ethics as ‘eating for change’; nationalism as a form of patriotic morality that encourages the consumption of national brands and protectionism; and nostalgic knowledge and historical identities of the past to reconfigure ethical ideals for the future. These discursive identity constructions shed light on how consumers may redefine food ethics in the future, legitimising citizenship through demonstrating virtue, patriotism as loyalty to social groups, and nostalgic capturing of history to ‘ethicise’ the future.
China's rapidly developing economy has seen an increase in medical problems commonly associated with affluent lifestyles such as increases in metabolic diseases and digestive issues. One response to ...this problem is an increase in the amount of functional foods currently available, which may take a Western food form, or be more closely associated with traditional Chinese medicine (TCM). This research seeks to understand how functional food and wellbeing intersect in order to better understand how consumers perceive the complex construct of wellbeing, and their agency in its creation. Interviews and Focus Group Interviews were undertaken in Shanghai, China; with consumers who self-identified as having health concerns, and with Doctors trained in Western Medicine and in TCM. Using an iterative process, the primary objective was to holistically examine how consumers navigate the role of functional foods in relation to their wellbeing. Our findings reveal three broad intersecting themes: (1) self-managed therapy using functional foods; (2) building trust with knowledge sharing; and (3) the importance of functional food heuristics. Functional food was not simply considered to be food with an added benefit, but also a cultural symbol of agency over one's wellness. These findings are discussed and implications for both policy makers and marketers are deliberated.
We determine whether the Clinical Frailty Scale applied at emergency department (ED) triage is associated with important service- and patient-related outcomes.
We undertook a single-center, ...retrospective cohort study examining hospital-related outcomes and their associations with frailty scores assessed at ED triage. Participants were aged 65 years or older, registered on their first ED presentation during the study period at a single, centralized ED in the United Kingdom. Baseline data included age, sex, Clinical Frailty Scale score, National Early Warning Score–2 and the Charlson Comorbidity Index score; outcomes included length of stay, readmissions (any future admissions), and mortality (inhospital or out of hospital) up to 2 years after ED presentation. Survival analysis methods (standard and competing risks) were applied to assess associations between ED triage frailty scores and outcomes. Unadjusted incidence curves and adjusted hazard ratios are presented.
A total of 52,562 individuals representing 138,328 ED attendances were included; participants’ mean age was 78.0 years, and 55% were women. Initial admission rates generally increased with frailty. Mean length of stay after 30- or 180-day follow-up was relatively low; all Clinical Frailty Scale categories included patients who experienced zero days’ length of stay (ie, ambulatory care) and patients with relatively high numbers of inhospital days. Overall, 46% of study participants were readmitted by the 2-year follow-up. Readmissions increased with Clinical Frailty Scale score up until a score of 6 and then attenuated. Mortality rates increased with increasing frailty; the adjusted hazard ratio was 3.6 for Clinical Frailty Scale score 7 to 8 compared with score 1 to 3.
Frailty assessed at ED triage (with the Clinical Frailty Scale) is associated with adverse outcomes in older people. Its use in ED triage might aid immediate clinical decisionmaking and service configuration.
Differentiated thyroid cancer (DTC) is associated with an excellent prognosis, but patients with distant metastatic DTC have a 10-year disease-specific survival (DSS) of just 50%. The incidence of ...distant metastatic DTC has steadily increased in the United States since the 1980s. The aim of this study was to examine trends in survival and treatment for patients with distant metastatic DTC.
In this population-based, retrospective cohort study, patients with distant metastatic DTC were identified from the Surveillance, Epidemiology, and End Results-13 cancer registry program. Multivariable logistic and Cox regression analyses were used to examine factors associated with DSS and management. Annual percentage changes in treatment patterns were calculated using log-linear regression.
During 1992-2018, 1991 patients (69.7% white, 58.0% female, 47.5% aged ≥65 years) were diagnosed with distant metastatic DTC. Papillary thyroid cancer was the most common histological type (74.5%). While the 10-year DSS for overall DTC increased over time (95.4% for patients diagnosed in 1992-1998, 96.6% in 1999-2008, and 97.3% in 2009-2018;
< 0.01), 10-year DSS for DTC with distant metastases did not change (50.2%, 47.3%, and 52.4%, respectively;
= 0.48). Ten-year DSS rates were reduced for patients aged ≥65 years (28.1%), patients undergoing nonsurgical treatment with external beam radiation therapy and/or systemic therapy (6.0%), and patients undergoing no/unknown treatment (32.8%). On multivariable analysis, oncocytic carcinoma, age 65-79 and ≥80 years, male sex, node-positive disease, larger tumor size, nonsurgical treatment, and no/unknown treatment were associated with increased risk of thyroid cancer death. Between 1992 and 2018, the rate of nonsurgical treatment increased, on average, 1.3% per year (1992-1998: 22.9% vs. 2009-2018: 25.6%;
= 0.03), and the rate of patients receiving no/unknown treatment increased 1.9% per year (1992-1998: 11.3% vs. 2009-2018: 15.6%;
= 0.01). Patients aged 65-79 and ≥80 years were more likely than younger patients to receive nonsurgical management or no/unknown treatment.
Patients diagnosed with distant metastatic DTC have experienced no improvement in DSS over the past three decades. An increasing proportion of patients diagnosed with distant metastatic DTC are receiving nonsurgical treatment or no/unknown treatment over time; the proportion was highest among the oldest patients.
Abstract
Human induced pluripotent stem cells (hiPSCs) not only provide an abundant source of vascular cells for potential therapeutic applications in vascular disease but also constitute an ...excellent model for understanding the mechanisms that regulate the differentiation and the functionality of vascular cells. Here, we reported that myocyte enhancer factor 2C (MEF2C) transcription factor, but not any other members of the MEF2 family, was robustly upregulated during the differentiation of vascular progenitors and endothelial cells (ECs) from hiPSCs. Vascular endothelial growth factors (VEGF) strongly induced MEF2C expression in endothelial lineage cells. The specific upregulation of MEF2C during the commitment of endothelial lineage was dependent on the extracellular signal regulated kinase (ERK). Moreover, knockdown of MEF2C with shRNA in hiPSCs did not affect the differentiation of ECs from these hiPSCs, but greatly reduced the migration and tube formation capacity of the hiPSC-derived ECs. Through a chromatin immunoprecipitation-sequencing, genome-wide RNA-sequencing, quantitative RT-PCR, and immunostaining analyses of the hiPSC-derived endothelial lineage cells with MEF2C inhibition or knockdown compared to control hiPSC-derived ECs, we identified TNF-related apoptosis inducing ligand (TRAIL) and transmembrane protein 100 (TMEM100) as novel targets of MEF2C. This study demonstrates an important role for MEF2C in regulating human EC functions and highlights MEF2C and its downstream effectors as potential targets to treat vascular malfunction-associated diseases.
Graphical Abstract
Graphical Abstract
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