Abstract
Background
frail patients in any age group are more likely to die than those that are not frail. We aimed to evaluate the impact of frailty on clinical mortality, readmission rate and length ...of stay for emergency surgical patients of all ages.
Methods
a multi-centre prospective cohort study was conducted on adult admissions to acute surgical units. Every patient presenting as a surgical emergency to secondary care, regardless of whether they ultimately underwent a surgical procedure was included. The study was carried out during 2015 and 2016.
Frailty was defined using the 7-point Clinical Frailty Scale. The primary outcome was mortality at Day 90. Secondary outcomes included: mortality at Day 30, length of stay and readmission within a Day 30 period.
Results
the cohort included 2,279 patients (median age 54 years IQR 36–72; 56% female). Frailty was documented in patients of all ages: 1% in the under 40’s to 45% of those aged 80+. We found that each incremental step of worsening frailty was associated with an 80% increase in mortality at Day 90 (OR 1.80, 95% CI: 1.61–2.01) supporting a linear dose–response relationship. In addition, the most frail patients were increasingly likely to stay in hospital longer, be readmitted within 30 days, and die within 30 days.
Conclusions
worsening frailty at any age is associated with significantly poorer patient outcomes, including mortality in unselected acute surgical admissions. Assessment of frailty should be integrated into emergency surgical practice to allow prognostication and implementation of strategies to improve outcomes.
Milk consumption in the United States has been in decline since the 1960s. Milk fat plays a critical role in sensory properties of fluid milk. The first objective of this study was to determine the ...change in percent milk fat needed to produce a detectable or just noticeable difference (JND) to consumers in skim, 1%, 2%, and whole milks. The second objective was to evaluate how milk fat affected consumer preferences for fluid milk. Threshold tests were conducted to determine the JND for each reference milk (skim, 1%, 2%, and whole milk), with a minimum of 60 consumers for each JND. The JND was determined for milks by visual appearance without tasting and tasting without visual cues. Serving temperature effect (4, 8, or 15°C) on tasting JND values were also investigated. The established JND values were then used to conduct ascending forced-choice preference tests with milks. Consumers were assigned to 3 groups based on self-reported milk consumption: skim milk drinkers (n = 59), low-fat milk drinkers (consumed 1% or 2% milk, n = 64), and whole milk drinkers (n = 49). Follow-up interviews were conducted where consumers were asked to taste and explain their preference between milks that showed the most polarization within each consumer segment. Descriptive sensory analysis was performed on the milks used in the follow-up interviews to quantify sensory differences. Visual-only JND were lower than tasting-only JND values. Preference testing revealed 3 distinct preference curves among the consumer segments. Skim milk drinkers preferred skim milk and up to 2% milk fat, but disliked milk higher in fat due to it being “too thick,” “too heavy,” “flavor and texture like cream,” “too fatty,” and “looks like half and half.” Low-fat milk drinkers preferred 2% milk up to 3.25% (whole milk), but then disliked higher milk fat content. Whole milk drinkers preferred whichever milk was higher in milk fat regardless of how high the fat content was, distinct from skim and low-fat milk drinkers. The findings of this study provide insights on sensory characteristics of milk fat in fluid milk and consumer sensory perception of these properties. These results also provide insights on how the industry might adjust milk fat references for adjusting milk sensory properties to increase milk preference and remain within the standards of identity of milk.
Background
Postoperative delirium (POD) is common after surgery. As age is a known risk factor, the increased ageing of the population undergoing surgery emphasizes the importance of the subject. ...Knowledge of other potential risk factors in older patients with surgical gastrointestinal diseases is lacking. The aim here was to collate and synthesize the published literature on risk factors for delirium in this group.
Methods
Five databases were searched (MEDLINE, Web of Science, Embase, CINAHL® and PSYCinfo®) between January 1987 and November 2014. The Newcastle–Ottawa Scale was used to rate study quality. Pooled odds ratios or mean differences for individual risk factors were estimated using the Mantel–Haenszel and inverse‐variance methods.
Results
Eleven studies met the inclusion criteria; they provided a total of 1427 patients (318 with delirium and 1109 without), and predominantly included patients undergoing elective colorectal surgery. The incidence of POD ranged from 8·2 to 54·4 per cent. A total of 95 risk factors were investigated, illustrating wide heterogeneity in study design. Seven statistically significant risk factors were identified in pooled analysis: old age, American Society of Anesthesiologists (ASA) physical status grade at least III, body mass index, lower serum level of albumin, intraoperative hypotension, perioperative blood transfusion and history of alcohol excess. Patients with POD had a significantly increased duration of hospital stay and a higher mortality rate compared with those without delirium.
Conclusion
Delirium is common in older patients undergoing gastrointestinal surgery. Several risk factors were consistently associated with POD.
Several significant risk factors
Hospital admissions for non-coronavirus disease 2019 (COVID-19) pathology have decreased significantly. It is believed that this may be due to public anxiety about acquiring COVID-19 infection in ...hospital and the subsequent risk of mortality.
To identify patients who acquire COVID-19 in hospital (nosocomial COVID-19 infection (NC)) and their risk of mortality compared to those with community-acquired COVID-19 (CAC) infection.
The COPE-Nosocomial Study was an observational cohort study. The primary outcome was the time to all-cause mortality (estimated with an adjusted hazard ratio (aHR)), and secondary outcomes were day 7 mortality and the time-to-discharge. A mixed-effects multivariable Cox's proportional hazards model was used, adjusted for demographics and comorbidities.
The study included 1564 patients from 10 hospital sites throughout the UK, and one in Italy, and collected outcomes on patients admitted up to April 28th, 2020. In all, 12.5% of COVID-19 infections were acquired in hospital; 425 (27.2%) patients with COVID died. The median survival time in NC patients was 14 days compared with 10 days in CAC patients. In the primary analysis, NC infection was associated with lower mortality rate (aHR: 0.71; 95% confidence interval (CI): 0.51–0.98). Secondary outcomes found no difference in day 7 mortality (adjusted odds ratio: 0.79; 95% CI: 0.47–1.31), but NC patients required longer time in hospital during convalescence (aHR: 0.49, 95% CI: 0.37–0.66).
The minority of COVID-19 cases were the result of NC transmission. No COVID-19 infection comes without risk, but patients with NC had a lower risk of mortality compared to CAC infection; however, caution should be taken when interpreting this finding.
Fluid milk consumption has declined for decades while consumption of nondairy alternatives has increased. A better understanding of why consumers purchase fluid milk or nondairy alternatives is ...needed to assist increased sales of milk or maintain sales without further decline. The objective of this study was to determine the extrinsic attributes that drive purchase within each product category. The second objective was to determine the personal values behind the purchase of each beverage type to give further understanding why particular attributes are important. An online conjoint survey was launched with 702 dairy consumers, 172 nondairy consumers, and 125 consumers of both beverages. Individual means-end chain interviews were conducted with fluid milk consumers (n = 75), plant-based alternative consumers (n = 68), and consumers of both beverages (n = 78). Fat content was the most important attribute for dairy milk followed by package size and label claims. Consumers of fluid milk preferred 1 or 2% fat content, gallon, or half-gallon packaging, conventionally pasteurized store-brand milk. Sugar level was the most important attribute for plant-based beverages, followed by plant source and package size. Almond milk was the most desirable plant source, and half-gallon packaging was the most preferred packaging. Means-end chain interviews results suggested that maintaining a balanced diet and healthy lifestyle was important to all consumer groups. Lactose free was an important attribute for plant-based alternative consumers and consumers of both dairy and nondairy. A distinguishing characteristic of those who only drank nondairy plant-based alternatives was that plant-based beverages contributed to a goal to consume less animal products, beliefs about animal mistreatment, and perceived lesser effect on the environment than fluid milk. Unique to fluid milk consumers was that fluid milk was perceived as a staple food item. These results suggest that the dairy industry should focus on the nutrition value of milk and educating consumers about misconceptions regarding dairy milk. Future beverage innovation should include the development of lactose-free milk that is also appealing to consumers in flavor.
During viral infection, proper regulation of immune responses is necessary to ensure successful viral clearance with minimal host tissue damage. Proteasomes play a crucial role in the generation of ...antigenic peptides for presentation on MHC class I molecules, and thus activation of CD8 T cells, as well as activation of the NF-κB pathway. A specialized type of proteasome called the immunoproteasome is constitutively expressed in hematopoietic cells and induced in non-immune cells during viral infection by interferon signaling. The immunoproteasome regulates CD8 T cell responses to many viral epitopes during infection. Accumulating evidence suggests that the immunoproteasome may also contribute to regulation of proinflammatory cytokine production, activation of the NF-κB pathway, and management of oxidative stress. Many viruses have mechanisms of interfering with immunoproteasome function, including prevention of transcriptional upregulation of immunoproteasome components as well as direct interaction of viral proteins with immunoproteasome subunits. A better understanding of the role of the immunoproteasome in different cell types, tissues, and hosts has the potential to improve vaccine design and facilitate the development of effective treatment strategies for viral infections.
Barley flour and barley flour-pomace (tomato, grape) blends were extruded through a co-rotating twin-screw extruder. The aim of the present study was to investigate the effects of die temperature, ...screw speed, and pomace level on water absorption index (WAI), water solubility index (WSI), degree of starch gelatinization, and in vitro starch digestibility using a response surface methodology. The selected extrudate samples were examined further using differential scanning calorimetry (DSC) and polarized light microscopy, respectively. The WAI of barley-pomace extrudates was affected by increasing pomace level. Temperature had significant effect on all types of extrudate but screw speed had significant linear effect only on barley and barley-grape pomace extrudates on degree of starch gelatinization. Although no gelatinization peak was detected, an endotherm was observed on all selected extrudates. In general, extrusion cooking significantly increased in vitro starch digestibility of extrudates. However, increasing level of both tomato and grape pomace led to reduction in starch digestibility.
A protocol is described for sequencing the transcriptome of a cell nucleus. Nuclei are isolated from specimens and sorted by FACS, cDNA libraries are constructed and RNA-seq is performed, followed by ...data analysis. Some steps follow published methods (Smart-seq2 for cDNA synthesis and Nextera XT barcoded library preparation) and are not described in detail here. Previous single-cell approaches for RNA-seq from tissues include cell dissociation using protease treatment at 30 °C, which is known to alter the transcriptome. We isolate nuclei at 4 °C from tissue homogenates, which cause minimal damage. Nuclear transcriptomes can be obtained from postmortem human brain tissue stored at -80 °C, making brain archives accessible for RNA-seq from individual neurons. The method also allows investigation of biological features unique to nuclei, such as enrichment of certain transcripts and precursors of some noncoding RNAs. By following this procedure, it takes about 4 d to construct cDNA libraries that are ready for sequencing.
Diatoms outcompete other phytoplankton for nitrate, yet little is known about the mechanisms underpinning this ability. Genomes and genome-enabled studies have shown that diatoms possess unique ...features of nitrogen metabolism however, the implications for nutrient utilization and growth are poorly understood. Using a combination of transcriptomics, proteomics, metabolomics, fluxomics, and flux balance analysis to examine short-term shifts in nitrogen utilization in the model pennate diatom in Phaeodactylum tricornutum, we obtained a systems-level understanding of assimilation and intracellular distribution of nitrogen. Chloroplasts and mitochondria are energetically integrated at the critical intersection of carbon and nitrogen metabolism in diatoms. Pathways involved in this integration are organelle-localized GS-GOGAT cycles, aspartate and alanine systems for amino moiety exchange, and a split-organelle arginine biosynthesis pathway that clarifies the role of the diatom urea cycle. This unique configuration allows diatoms to efficiently adjust to changing nitrogen status, conferring an ecological advantage over other phytoplankton taxa.
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