Integrated gut metabolome and microbiome fingerprinting reveals that dysbiosis precedes allergic inflammation in IgE-mediated pediatric cow's milk allergy.

BACKGROUND: IgE-mediated cow's milk allergy (IgE-CMA) is one of the first allergies to arise in early childhood and may result from exposure to various milk allergens, of which ß-lactoglobulin (BLG) and casein are the most important. Understanding the underlying mechanisms behind IgE-CMA is imperative for the discovery of novel biomarkers and the design of innovative treatment and prevention strategies. METHODS: We report a longitudinal in vivo murine model, in which two mice strains (BALB/c and C57Bl/6) were sensitized to BLG using either cholera toxin or an oil emulsion (n = 6 per group). After sensitization, mice were challenged orally, their clinical signs monitored, antibody (IgE and IgG1) and cytokine levels (IL-4 and IFN-γ) measured, and fecal samples subjected to metabolomics. The results of the murine models were further extrapolated to fecal microbiome-metabolome data from our population of IgE-CMA (n = 22) and healthy (n = 23) children (Trial: NCT04249973), on which polar metabolomics, lipidomics and 16S rRNA metasequencing were performed. In vitro gastrointestinal digestions and multi-omics corroborated the microbial origin of proposed metabolic changes. RESULTS: During mice sensitization, we observed multiple microbially derived metabolic alterations, most importantly bile acid, energy and tryptophan metabolites, that preceded allergic inflammation. We confirmed microbial dysbiosis, and its associated effect on metabolic alterations in our patient cohort, through in vitro digestions and multi-omics, which was accompanied by metabolic signatures of low-grade inflammation. CONCLUSION: Our results indicate that gut dysbiosis precedes allergic inflammation and nurtures a chronic low-grade inflammation in children on elimination diets, opening important new opportunities for future prevention and treatment strategies.

Capturing the whole-school food environment in primary schools.

OBJECTIVE: The school food environment (SFE) is an ideal setting for encouraging healthy dietary behaviour. We aimed to develop an instrument to assess whole-SFE, test the instrument in the school setting and demonstrate its use to make food environment recommendations. DESIGN: SFE literature and UK school food guidance were searched to inform instrument items. The instrument consisted of (i) an observation proforma capturing canteen areas systems, food presentation and monitoring of food intake and (ii) a questionnaire assessing food policies, provision and activities. The instrument was tested in schools and used to develop SFE recommendations. Descriptive analyses enabled narrative discussion. SETTING: Primary schools. PARTICIPANTS: An observation was undertaken at schools in urban and rural geographical regions of Northern Ireland of varying socio-economic status (n 18). School senior management completed the questionnaire with input from school caterers (n 16). RESULTS: The instrument captured desired detail and potential instrument modifications were identified. SFE varied. Differences existed between food policies and how policies were implemented and monitored. At many schools, there was scope to enhance physical eating environments (n 12, 67 %) and food presentation (n 15, 83 %); emphasise healthy eating through food activities (n 7, 78 %) and increase parental engagement in school food (n 9, 56 %). CONCLUSIONS: The developed instrument can measure whole-SFE in primary schools and also enabled identification of recommendations to enhance SFE. Further assessment and adaptation of the instrument are required to enable future use as a research tool or for self-assessment use by schools.

Consumers' perceptions and willingness to purchase pork labelled 'raised without antibiotics'.

As a recent addition to the UK market, it is unknown how 'raised without antibiotics' labelled products are perceived or how they influence consumer food choice. Understanding consumers' perceptions towards the 'raised without antibiotics' label can determine knowledge of the label and what drives them to purchase products raised without antibiotics. Subsequently, using an online questionnaire with 1000 participants aged 18-92 years old, this study explored UK consumers' perceptions and willingness to buy 'raised without antibiotics' labelled pork, and examined their knowledge of antimicrobial use and antimicrobial resistance (AMR1). Cross-sectional data were collected investigating consumer perceptions and willingness to purchase 'raised without antibiotics' labelled pork and hierarchical multiple regression analyses were conducted. Respondents had high levels of knowledge towards EU regulations however, their awareness of AMR was limited. Behavioural beliefs concerning animal welfare and product quality were the main predictors of consumers' willingness to buy 'raised without antibiotics' labelled pork, followed by pork purchasing habits based on animal welfare qualities. Additionally, consumers who were more concerned that AMR would personally affect them, as well as those who favoured antimicrobial use for the preservation of animal welfare were willing to buy this product. Perceptions towards animal antimicrobial use acceptance, beliefs that 'raised without antibiotics' labelled pork is expensive, and a lack of consideration for extrinsic qualities when purchasing pork i.e., appearance, had a negative influence on willingness to buy. Moderate perceptions towards 'raised without antibiotics' labelled pork, lack of knowledge of agricultural antimicrobial use, and the subsequent confusion surrounding this label suggests that it is necessary to explore other labelling options to provide consumers with the information they desire while also safeguarding animal welfare.

Effective approaches for early identification and proactive mitigation of aflatoxins in peanuts: An EU-China perspective.

Nearly 700,000 tonnes of peanuts are consumed annually in Europe. In the last 5 years, peanuts imported from China exceeded legal European Union (EU) aflatoxin limits more than 180 times. To prevent and mitigate aflatoxin contamination, the stages of the peanut chain most vulnerable to contamination must be assessed to determine how to interrupt the movement of contaminated produce. This paper discusses effective approaches for early identification and proactive mitigation of aflatoxins in peanuts to reduce a contaminant that is an impediment to trade. We consider (i) the results of the EU Commission's Directorate-General (DG) for Health and Food Safety review, (ii) the Code of Practice for the prevention and reduction of aflatoxins in peanuts issued by Food and Agriculture Organization/World Health Organization, (iii) the results from previous EU-China efforts, and (iv) the latest state-of-the-art technology in pre- and postharvest methods as essential elements of a sustainable program for integrated disease and aflatoxin management. These include preharvest use of biocontrol, biofertilizers, improved tillage, forecasting, and risk monitoring based on analysis of big data obtained by remote sensing. At the postharvest level, we consider rapid testing methods along the supply chain, Decision Support Systems for effective silo management, and effective risk monitoring during drying, storage, and transport. Available guidance and current recommendations are provided for successful practical implementation. Food safety standards also influence stakeholder and consumer trust and confidence, so we also consider the results of multiactor stakeholder group discussions.

Food environment intervention improves food knowledge, wellbeing and dietary habits in primary school children: Project Daire, a randomised-controlled, factorial design cluster trial.

BACKGROUND: Evidence suggests that dietary intake of UK children is suboptimal. As schools provide an ideal natural environment for public health interventions, effective and sustainable methods of improving food knowledge and dietary habits in this population must be identified. Project Daire aimed to improve children's health-related quality of life, wellbeing, food knowledge and dietary habits via two multi-component interventions. METHODS: Daire was a randomised-controlled, factorial design trial evaluating two interventions across four arms. Primary schools in Northern Ireland were randomised to one of four 6-month intervention arms: i) 'Nourish', ii) 'Engage', iii) 'Nourish' and 'Engage' and iv) Control (Delayed). 'Nourish' was an intervention aiming to alter the whole-school food environment, provide food-related experiences and exposure to locally produced foods. 'Engage' was an age-appropriate, cross-curricular educational intervention on food, agriculture, nutrition science and related careers. Primary outcomes were emotional and behavioural wellbeing and health-related quality of life. A number of secondary outcomes, including dietary intake, cooking competence and food-related knowledge, were also measured. RESULTS: Fifteen schools from areas of varying socio-economic status participated in the randomised trial. A total of 903 (n = 445 aged 6-7 years and n = 458 aged 10-11 years) primary school pupils took part. Total Difficulties Score improved in all pupils (6-7 and 10-11 year old pupils) who received the 'Nourish' intervention compared with those that did not (adjusted difference in mean = - 0.82; 95% CI -1.46, - 0.17; P < 0.02). No statistically significant difference in Health-Related Quality of Life was observed. The 'Nourish' intervention also produced some changes in school-based dietary behaviour, which were most apparent in the 10-11 year old pupils. The 'Nourish' intervention also produced improvements in understanding of food labels (adjusted difference in mean = 0.15; 95% CI 0.05, 0.25; P < 0.01) and knowledge of vegetables in season (adjusted difference in mean = 0.29; 95% CI 0.01,0.56; P = 0.04) whilst an increased willingness to try new foods and improved perceived cooking competence was also observed. CONCLUSIONS: Improvements in childhood emotional and behavioural wellbeing, dietary intake, knowledge about food, cooking skills and willingness to try new foods were associated with the 'Nourish' whole-school food environment intervention. Exploration of the sustainability and long-term effectiveness of such whole-school food interventions should be conducted. TRIAL REGISTRATION: National Institute of Health (NIH) U.S. National Library of Medicine Clinical Trials.gov (ID: NCT04277312 ).

Emotional labour: learning from the past, understanding the present.

The number of nurses considering leaving the profession has continued to rise, and in many areas there is a nursing shortfall. For many of those leaving the profession, the decision results from workplace stress. This article examines the concept of emotional labour, which has been linked to compassion fatigue and subsequent burnout. Emotional labour is the term used to describe the process of displaying outward emotion that may not match our internal emotion; this dissonance can lead to highly stressful situations. The concept is explored from a genealogical perspective, specifically focusing on how gender, socio-political and health cultures have influenced the evolution of the discourse that defines how emotional labour is perceived, understood and valued. This article will identify what has shaped the discourse and how the historical influences have influenced perceptions. The article identifies that emotional labour has traditionally been viewed as women's work and has been undervalued. The influence of male nurses and the gradual decline of heavy industry has served to improve the understanding and value of the concept. Lessons from the past can inform the management of the stresses of emotional labour. Emotional labour is a recognised component of workplace stress and this article makes a number of recommendations for further research or management strategies, which may assist in the recognition and management of the stresses nurses face when delivering emotionally demanding care.

Identifying and managing underperformance in nursing students: lessons from practice.

This article presents an analysis of the reflective practice of mentors and student nurses who were interviewed as part of a personal skill improvement project. Colleagues and students were asked to provide feedback on their perceptions of how the author demonstrated the skill of identifying and managing underperformance in nursing students. Their narratives were examined with the intention of identifying areas for improving underperformance and how it could be managed in future. Key findings were the requirement for mentors to increase engagement with students, especially in terms of protected time, participatory learning, honest and open dialogue and the need for a commitment to building a supportive and effective mentor-student relationship. This article offers insight into how current mentors and students perceive the management of underperformance and raises awareness of related issues in an attempt to improve mentoring practice.

Identifying and managing underperformance in nursing students.

Student nurses are the future of the profession and require high levels of commitment and skill from the registered nurses charged with mentoring and guiding them on the road to registration. Evidence suggests that mentors are failing to recognise underperformance and as such are missing opportunities to effectively manage and encourage improvement in failing students. The literature is also demonstrative of mentors failing to fail students who do not achieve requisite standards, thus allowing sub-optimal students to progress on towards registration. This article examines literature relating to effective management of underperforming students in clinical practice and the need to fail those who do not meet the required standards. The article seeks to provide mentors with an understanding of why some are 'failing to fail', as well as highlighting implications for skill improvement. It is the result of an ongoing local skill-improvement project. Key themes for improvement are discussed including issues of mentor confidence, early identification of underperformance, improving mentor-student relationships and the need for open, honest communication.

Complex interactions between dioxin-like and non-dioxin-like compounds for in vitro cellular responses: implications for the identification of dioxin exposure biomarkers.

Despite considerable advances in reducing the production of dioxin-like toxicants in recent years, contamination of the food chain still occasionally occurs resulting in huge losses to the agri-food sector and risk to human health through exposure. Dioxin-like toxicity is exhibited by a range of stable and bioaccumulative compounds including polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs), produced by certain types of combustion, and man-made coplanar polychlorinated biphenyls (PCBs), as found in electrical transformer oils. While dioxinergic compounds act by a common mode of action making exposure detection biomarker based techniques a potentially useful tool, the influence of co-contaminating toxicants on such approaches needs to be considered. To assess the impact of possible interactions, the biological responses of H4IIE cells to challenge by 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in combination with PCB-52 and benzo-a-pyrene (BaP) were evaluated by a number of methods in this study. Ethoxyresorufin-O-deethylase (EROD) induction in TCDD exposed cells was suppressed by increasing concentrations of PCB-52, PCB-153, or BaP up to 10 µM. BaP levels below 1 µM suppressed TCDD stimulated EROD induction, but at higher concentrations, EROD induction was greater than the maximum observed when cells were treated with TCDD alone. A similar biphasic interaction of BaP with TCDD co-exposure was noted in the AlamarBlue assay and to a lesser extent with PCB-52. Surface enhanced laser desorption/ionization-time of flight mass spectrometry (SELDI-TOF) profiling of peptidomic responses of cells exposed to compound combinations was compared. Cells co-exposed to TCDD in the presence of BaP or PCB-52 produced the most differentiated spectra with a substantial number of non-additive interactions observed. These findings suggest that interactions between dioxin and other toxicants create novel, additive, and non-additive effects, which may be more indicative of the types of responses seen in exposed animals than those of single exposures to the individual compounds.

Public and patient research priorities for orthostatic hypotension.

With a rapidly expanding older population and increased survival of older people with chronic disease, we can expect to see increasing numbers of people with orthostatic hypotension (OH). Unfortunately the evidence base for people with OH, with particular relevance to older people, has not kept up and has resulted in a real lack of progress and little good evidence. There are several areas of research that could potentially benefit patients but establishing which ones are priority areas requires public and patient involvement (PPI). This process includes people/patients in the research team to maximise the relevance, success and translation of the research. This brief report describes the early involvement of older people in prioritising the research question, methods to improve adherence during a trial and the preferred methods to disseminate research output. The individuals' priority was to research non-pharmacological treatment strategies and to improve the education of patients about their condition. Education was felt to be the best strategy to promote adherence during a trial, with change in symptoms and quality of life felt to be the most important outcome measures as opposed to blood pressure. This report offers guidance for academics that are undertaking OH-related research and how they can improve its relevance and increase its translation into clinical practice.

Unprecedented Harmful algal bloom in the UK and Ireland's largest lake associated with gastrointestinal bacteria, microcystins and anabaenopeptins presenting an environmental and public health risk.

Harmful Algal Blooms (HABs) are outbreaks of aquatic toxic microalgae emerging as a global problem driven by nutrient enrichment, global climate change and invasive species. We uniquely describe a HAB of unprecedented duration, extent and magnitude during 2023 in Lough Neagh; the UK and Ireland's largest freshwater lake, using an unparalleled combination of satellite imagery, nutrient analysis, 16S rRNA gene sequencing and cyanotoxin profiling. The causative agent Microcystis aeruginosa accounted for over a third of DNA in water samples though common bacterioplankton species also bloomed. Water phosphate levels were hypertrophic and drove local algal biomass. The HAB pervaded the entire ecosystem with algal mats accumulating around jetties, marinas and lock gates. Over 80 % of bacterial DNA isolated from algal mat samples consisted of species associated with wildfowl or livestock faeces and human-effluent wastewater including 13 potential pathogens that can cause serious human illness including: E. coli, Salmonella, Enterobacter and Clostridium among others. Ten microcystins, nodularin and two anabaenopeptin toxins were confirmed as present (with a further microcystin and four anabaenopeptins suspected), with MC-RR and -LR in high concentrations at some locations (1,137-18,493 µg/L) with MC-LR exceeding World Health Organisation (WHO) recreational exposure guidelines in all algal mats sampled. This is the first detection of anabaenopeptins in any waterbody on the island of Ireland. Notwithstanding the ecological impacts, this HAB represented an environmental and public health risk, curtailing recreational activities in-and-around the lake and damaging local businesses. Reducing agricultural runoff and discharge from human-effluent wastewater treatment to manage nutrient loading, and the public health risk, should be the top priority of stakeholders, especially government. Key recommendations include Nature-based Solutions that avoid conflict with the productivity and profitability of the farming sector enhancing sustainability. We hope this stimulates real-world action to resolve the problems besetting this internationally important ecosystem.

Functional impairment in alcoholic liver disease and non-alcoholic fatty liver disease is significant and persists over 3 years of follow-up.

BACKGROUND AND AIMS: Alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) are common and increasing in prevalence. We examined prevalence and predictors of functional impairment in biopsy-proven ALD and NAFLD. Change in function over 3 years was explored. METHODS: Validated functional, cognitive, autonomic, and fatigue symptom assessment tools were completed by patients who had attended our liver clinic. RESULTS: Totals of 224 NAFLD and 107 ALD patients returned the assessment tools. NAFLD and ALD demonstrated comparable functional difficulties, which were significantly worse than controls (p < 0.001) with the proportion of participants experiencing difficulty significantly higher [x (2) 8.93(3), (p = 0.01)]. No significant functional difficulty was demonstrated between those participants who were pre-cirrhotic or cirrhotic. Independent associations were present between difficulty with function in ALD and higher burden of autonomic and cognitive symptoms (p = 0.02) and in NAFLD-increased cognitive difficulty (p < 0.0001), age (p = 0.001), fatigue (p = 0.01), lower albumin (p = 0.02), and bilirubin (p = 0.04). PHAQ scores increased 21 % 2008-2011 {(3.2/15.6) [15.6 (0-93.8)] to 18.75 (0-90.6)}. Functional difficulty of participants alive [15.6 (0-96.9)] was significantly less compared to those who died [40.6 (0-100)] (p = 0.02). CONCLUSIONS: NAFLD and ALD patients experience significant functional impairment affecting activities of daily living that persists over time. This has implications for the management of liver disease and service provision.

Falls and fall-related injury are common in older people with chronic liver disease.

BACKGROUND: Improved survival with chronic liver disease (CLD) and increased incidence in the older has led to a rapidly expanding population which faces similar "geriatric syndromes" as the general population. With risk factors such as autonomic dysfunction, cognitive impairment, and muscle abnormalities in CLD it is expected that falls and injury will be common. AIM: To determine prevalence of falls and injury in chronic liver disease and to identify potential modifiable fall associations. METHODS: Falls prevalence was estimated by providing patients aged ≥ 65 years with CLD a falls data collection tool, via the post or in the clinic. A younger CLD cohort and age-matched and sex-matched community controls was used for comparison. A sub-group underwent multidisciplinary falls assessment to identify modifiable fall associations. RESULTS: Falls were significantly more common in older people with CLD (47 % in previous year) than in controls; incidence of injury did not differ. Regression identified orthostatic symptoms, lower-limb strength, and fear of falling as being independently associated with falls in CLD. Those who had fallen had significantly greater difficulty with daily activities. CONCLUSION: Falls are prevalent in older people with CLD, and are potentially preventable with multifactorial intervention. Services must prepare for expansion in the older CLD population; here we demonstrate how this expansion may affect falls services and provide a potential therapeutic target.

Consumer purchase intention towards a quick response (QR) code for antibiotic information: an exploratory study.

Increasing awareness of antimicrobial resistance (AMR) has raised concerns surrounding antimicrobial use (AMU) in food-producing animals and has focused attention towards livestock production free from antibiotic use. As antibiotic-free livestock production proliferates in the UK, there is an increasing need to implement a system, such as the use of a QR code, to provide consumers with reliable antibiotic information while ensuring that animal welfare standards are upheld. Subsequently, this study aims to explore UK consumers' perceptions and purchase intention towards QR code labelled pork, and to identify determinants of its purchase, incorporating various theoretical constructs from the Theory of Planned Behaviour. Based on results, consumers' perceptions, perceived control, and attitudes towards QR code labelled pork are the main determinants of purchase intention. QR code labelled pork may offer a suitable alternative to antibiotic-free labelling as it provides consumers with antibiotic information without inadvertently communicating that conventionally produced pork is unsafe.

Smartphone-based magneto-immunosensor on carbon black modified screen-printed electrodes for point-of-need detection of aflatoxin B1 in cereals.

Considering the complexities and speed of modern food chains, there is an increasing demand for point-of-need detection of food contaminants, particularly highly regulated chemicals and carcinogens such as aflatoxin B1. We report a user-friendly smartphone-based magneto-immunosensor on carbon black modified electrodes for point-of-need detection of aflatoxin B1 in cereals. For buffered analyte solutions and a corn extract sample, the assay demonstrated a low limit of detection of 13 and 24 pg/mL, respectively. The assay was also highly reproducible, exhibiting mean relative standard deviations of 3.7% and 4.0% for the buffered analyte and corn extract samples. The applicability of the assay was validated on the basis of EU guidelines and the detection capability was lower than or equal to 2 µg/kg, which is the EU maximum residue limit for aflatoxin B1 in cereals. False-positive and false-negative rates were less than 5%. Additionally, an open-source android application, AflaESense, was designed to provide a simple interface that displays the result in a traffic-light-type format, thus minimizing user training and time for data analysis. AflaESense was used for smartphone-based screening of spiked corn samples containing aflatoxin B1 (0.1, 2, and 10 ng/mL), and naturally contaminated corn containing 0.15 ng aflatoxin B1/mL. The measured values were in close agreement with spiked concentrations (r2 = 0.99), with recovery values ranging between 80 and 120%. Finally, contaminated samples correctly triggered a red alert while the non-contaminated samples led to the display of a green color of AflaESense. To the best of our knowledge, this is the first smartphone-based electrochemical system effective for screening samples for contamination with aflatoxin B1.

Verification of Bound Aminoguanidine as the Marker Residue for the Banned Antibiotic, Nitrovin, in Pig Tissues.

Nitrovin (NTV) belongs to a class of antibiotics called nitrofurans, which are classified as nonallowed pharmacologically active substances that do not have a maximum residue limit listed in EU legislation. The objectives of this study were to confirm aminoguanidine (AGN) as a suitable marker residue to monitor NTV abuse and to investigate its persistence in porcine tissues. In this work, pigs were fed with NTV-medicated feed (50 mg/kg), and tissues (kidney, muscle, and liver) and plasma were collected on different withdrawal days. All samples were analyzed for bound AGN, total AGN, and the parent drug NTV itself. The highest concentrations of AGN residues were found in the liver, while the lowest were in muscle. Parent NTV was only detected in the kidney at low levels on day 0 of withdrawal. The findings are in support of using AGN as the marker residue for monitoring the illegal use of NTV in animal-derived products.

Investigating the effects of physiological bile acids on GLP-1 secretion and glucose tolerance in normal and GLP-1R(-/-) mice.

Physiological secretion of bile acids has previously been linked to the regulation of blood glucose. GLP-1 is an intestinal peptide hormone with important glucose-lowering actions, such as stimulation of insulin secretion and inhibition of glucagon secretion. In this investigation, we assessed the ability of several bile acid compounds to secrete GLP-1 in vitro in STC-1 cells. Bile acids stimulated GLP-1 secretion from 3.3- to 6.2-fold but some were associated with cytolytic effects. Glycocholic and taurocholic acids were selected for in vivo studies in normal and GLP-1R(-/-) mice. Oral glucose tolerance tests revealed that glycocholic acid did not affect glucose excursions. However, taurocholic acid reduced glucose excursions by 40% in normal mice and by 27% in GLP-1R(-/-) mice, and plasma GLP-1 concentrations were significantly elevated 30 min post-gavage. Additional studies used incretin receptor antagonists to probe involvement of GLP-1 and GIP in taurocholic acid-induced glucose lowering. The findings suggest that bile acids partially aid glucose regulation by physiologically enhancing nutrient-induced GLP-1 secretion. However, GLP-1 secretion appears to be only part of the glucose-lowering mechanism and our studies indicate that the other major incretin GIP is not involved.

Reduction in functional ability is significant postliver transplantation compared with matched liver disease and community dwelling controls.

We compared functional ability and symptom severity in liver transplant recipients and matched chronic liver disease (CLD) and community controls. A total of 103/140 consecutive liver transplant recipients from a single centre (73%) and matched controls completed the patient-reported functional outcome measure: Patient-Reported Outcomes Measurement Information System, Health Assessment Questionnaire (PROMIS HAQ). Symptoms frequently seen in CLD were quantified by (i) Fatigue Impact Scale (FIS), (ii) Orthostatic Grading Scale (OGS: autonomic dysfunction), (iii) Cognitive Failures Questionnaire (CFQ) and (iv) Epworth Sleepiness Scale (ESS: Daytime somnolence). Liver transplant recipients exhibited significant reduction in function (P<0.0001) across all domains of the PROMIS HAQ suggesting that functional impairment is broad-based. Seventy-seven per cent of all postliver transplants identified some difficulty with activities of daily living. There was no relationship between PROMIS HAQ and liver biochemistry (r²=0.04, P=NS) or time since transplant (r² =0.1, P=NS). Elevation in PROMIS HAQ (and therefore functional impairment) strongly associated with symptoms, particularly fatigue, cognitive impairment and daytime somnolence. Fatigue severity was independently associated with functional impairment (FIS) (Beta 0.727, P < 0.0001). Symptoms or functional ability was not different between liver transplant recipients and matched chronic liver disease controls. Although survival postliver transplantation is improving, our cross-sectional study suggests that functional ability may not improve postliver transplantation. Further study is warranted to address the mechanisms responsible for post-transplant functional impairment and to develop effective rehabilitation regimes to maximize function following liver transplantation.

Osteoporosis, Fractures, and Bone Mineral Density Screening in Veterans With Kidney Stone Disease.

Whether a link exists between kidney stone disease and osteoporosis or fractures remains an open question. In this retrospective cohort study, we sought to determine the prevalence of osteoporosis and fractures and rate of bone mineral density screening by dual-energy X-ray absorptiometry (DXA) in patients with kidney stone disease. We examined nationwide data from the Veterans Health Administration and identified 531,431 patients with kidney stone disease between 2007 and 2015. Nearly 1 in 4 patients (23.6%, 95% confidence interval [CI] 23.5-23.7) with kidney stone disease had a prevalent diagnosis of osteoporosis or fracture. In patients with no prior history of osteoporosis or bone mineral density assessment before a kidney stone diagnosis, 9.1% were screened with DXA after their kidney stone diagnosis, of whom 20% were subsequently diagnosed with osteoporosis. Our findings provide support for wider use of bone mineral density screening in patients with kidney stone disease, including middle-aged and older men, a group less well recognized as at risk for osteoporosis or fractures. © 2021 American Society for Bone and Mineral Research (ASBMR).

Making complex measurements of meat composition fast: Application of rapid evaporative ionisation mass spectrometry to measuring meat quality and fraud.

Increasing demands are being placed on meat producers to verify more about their product with regards to safety, quality and authenticity. There are many methods that can detect aspects of these parameters in meat, yet most are too slow to keep up with the demands of modern meat processing plants and supply chains. A new technology, Rapid Evaporative Ionisation Mass Spectrometry (REIMS), has the potential to bridge the gap between advanced laboratory measurements and technology that can screen for quality, safety and authenticity parameters in a single measurement. Analysis with REIMS generates a detailed mass spectral fingerprint representative of a meat sample without the need for sample processing. REIMS has successfully been used to detect species fraud, detect use of hormones in meat animals, monitor meat processing and to detect off flavours such as boar taint. The aim of this review is to summarize these and other applications to highlight the potential of REIMS for meat analysis. Sampling methods and important considerations for data analysis are discussed as well as limitations of the technology and remaining challenges for practical adoption.