The prevalence of hyperglycaemia and its relationship with mortality, readmissions and length of stay in an older acute surgical population: a multicentre study.

BACKGROUND: The purpose of the study is to examine the prevalence of hyperglycaemia in an older acute surgical population and its effect on clinically relevant outcomes in this setting. METHODS: Using Older Persons Surgical Outcomes Collaboration (OPSOC) multicentre audit data 2014, we examined the prevalence of admission hyperglycaemia, and its effect on 30-day and 90-day mortality, readmission within 30 days and length of acute hospital stay using logistic regression models in consecutive patients, ≥65 years, admitted to five acute surgical units in the UK hospitals in England, Scotland and Wales. Patients were categorised in three groups based on their admission random blood glucose: <7.1, between 7.1 and 11.1 and ≥11.1 mmol/L. RESULTS: A total of 411 patients (77.25±8.14 years) admitted during May and June 2014 were studied. Only 293 patients (71.3%) had glucose levels recorded on admission. The number (%) of patients with a blood glucose <7.1, 7.1-11.1 and ≥11.1 mmol/L were 171 (58.4), 99 (33.8) and 23 (7.8), respectively. On univariate analysis, admission hyperglycaemia was not predictive of any of the outcomes investigated. Although the characteristics of those with no glucose level were not different from the included sample, 30-day mortality was significantly higher in those who had not had their admission glucose level checked (10.2% vs 2.7%), suggesting a potential type II error. CONCLUSION: Despite current guidelines, nearly a third of older people with surgical diagnoses did not have their glucose checked on admission highlighting the challenges in prognostication and evaluation research to improve care of older frail surgical patients.

Standardised and automated assessment of head computed tomography reliably predicts poor functional outcome after cardiac arrest: a prospective multicentre study.

PURPOSE: Application of standardised and automated assessments of head computed tomography (CT) for neuroprognostication after out-of-hospital cardiac arrest. METHODS: Prospective, international, multicentre, observational study within the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial. Routine CTs from adult unconscious patients obtained > 48 h ≤ 7 days post-arrest were assessed qualitatively and quantitatively by seven international raters blinded to clinical information using a pre-published protocol. Grey-white-matter ratio (GWR) was calculated from four (GWR-4) and eight (GWR-8) regions of interest manually placed at the basal ganglia level. Additionally, GWR was obtained using an automated atlas-based approach. Prognostic accuracies for prediction of poor functional outcome (modified Rankin Scale 4-6) for the qualitative assessment and for the pre-defined GWR cutoff < 1.10 were calculated. RESULTS: 140 unconscious patients were included; median age was 68 years (interquartile range [IQR] 59-76), 76% were male, and 75% had poor outcome. Standardised qualitative assessment and all GWR models predicted poor outcome with 100% specificity (95% confidence interval [CI] 90-100). Sensitivity in median was 37% for the standardised qualitative assessment, 39% for GWR-8, 30% for GWR-4 and 41% for automated GWR. GWR-8 was superior to GWR-4 regarding prognostic accuracies, intra- and interrater agreement. Overall prognostic accuracy for automated GWR (area under the curve [AUC] 0.84, 95% CI 0.77-0.91) did not significantly differ from manually obtained GWR. CONCLUSION: Standardised qualitative and quantitative assessments of CT are reliable and feasible methods to predict poor functional outcome after cardiac arrest. Automated GWR has the potential to make CT quantification for neuroprognostication accessible to all centres treating cardiac arrest patients.

Microplastic adulteration in homogenized fish and seafood - a mid-infrared and machine learning proof of concept.

The objective of this study was to assess the ability of utilizing attenuated total reflection mid-infrared (ATR-MIR) spectroscopy in combination with machine learning techniques to classify the presence of different types of microplastics in artificially adulterated fish and seafood samples. Different polymers namely poly-vinyl chloride (PVC), polycarbonate (PC), polystyrene (PS), polypropylene (PP) and low (LDPE) and high-density polyethylene (HDPE) were mixed with homogenized fish and seafood samples. Homogenized samples were analyzed using MIR spectroscopy and classification models developed using machine learning algorithms such as partial least squares discriminant analysis (PLS-DA). The results of this study revealed that it was possible to identify between adulterated and non-adulterated samples as well as the different microplastic types added to the homogenized samples using ATR-MIR spectroscopy. This study confirmed the ability of combining machine learning methods with ATR-MIR spectroscopy to directly analyze microplastic adulteration in fleshy foods such as fish and seafood. This proof-of-concept study can be utilized and extended to monitor the presence of plastics either in a wide range of fleshy foods or along the entire food value chain.

Distinguishing factors that influence attendance and behaviour change in family-based treatment of childhood obesity: A qualitative study.

OBJECTIVES: For the effective treatment of childhood obesity, intervention attendance and behaviour change at home are both important. The purpose of this study was to qualitatively explore influences on attendance and behaviour change during a family-based intervention to treat childhood obesity in the North West of England (Getting Our Active Lifestyles Started (GOALS)). DESIGN: Focus groups with children and parents/carers as part of a broader mixed-methods evaluation. METHODS: Eighteen focus groups were conducted with children (n = 39, 19 boys) and parents/carers (n = 34, 5 male) to explore their experiences of GOALS after 6 weeks of attendance (/18 weeks). Data were analysed thematically to identify influences on attendance and behaviour change. RESULTS: Initial attendance came about through targeted referral (from health care professionals and letters in school) and was influenced by motivations for a brighter future. Once at GOALS, it was the fun, non-judgemental healthy lifestyle approach that encouraged continued attendance. Factors that facilitated behaviour change included participatory learning as a family, being accountable and gradual realistic goal setting, whilst challenges focussed on fears about the intervention ending and a lack of support from non-attending significant others. CONCLUSIONS: Factors that influence attendance and behaviour change are distinct and may be important at different stages of the family's change process. Practitioners are encouraged to tailor strategies to support both attendance and behaviour change, with a focus on whole family participation within and outside the intervention.

Drosophila BubR1 is essential for meiotic sister-chromatid cohesion and maintenance of synaptonemal complex.

The partially conserved Mad3/BubR1 protein is required during mitosis for the spindle assembly checkpoint (SAC). In meiosis, depletion causes an accelerated transit through prophase I and missegregation of achiasmate chromosomes in yeast [1], whereas in mice, reduced dosage leads to severe chromosome missegregation [2]. These observations indicate a meiotic requirement for BubR1, but its mechanism of action remains unknown. We identified a viable bubR1 allele in Drosophila resulting from a point mutation in the kinase domain that retains mitotic SAC activity. In males, we demonstrate a dose-sensitive requirement for BubR1 in maintaining sister-chromatid cohesion at anaphase I, whereas the mutant BubR1 protein localizes correctly. In bubR1 mutant females, we find that both achiasmate and chiasmate chromosomes nondisjoin mostly equationally consistent with a defect in sister-chromatid cohesion at late anaphase I or meiosis II. Moreover, mutations in bubR1 cause a consistent increase in pericentric heterochromatin exchange frequency, and although the synaptonemal complex is set up properly during transit through the germarium, it is disassembled prematurely in prophase by stage 1. Our results demonstrate that BubR1 is essential to maintain sister-chromatid cohesion during meiotic progression in both sexes and for normal maintenance of SC in females.

Nano-plastics and their analytical characterisation and fate in the marine environment: From source to sea.

Polymer contamination is a major pollutant in all waterways and a significant concern of the 21st Century, gaining extensive research, media, and public attention. The polymer pollution problem is so vast; plastics are now observed in some of the Earth's most remote regions such as the Mariana trench. These polymers enter the waterways, migrate, breakdown; albeit slowly, and then interact with the environment and the surrounding biodiversity. It is these biodiversity and ecosystem interactions that are causing the most nervousness, where health researchers have demonstrated that plastics have entered the human food chain, also showing that plastics are damaging organisms, animals, and plants. Many researchers have focused on reviewing the macro and micro-forms of these polymer contaminants, demonstrating a lack of scientific data and also a lack of investigation regarding nano-sized polymers. It is these nano-polymers that have the greatest potential to cause the most harm to our oceans, waterways, and wildlife. This review has been especially ruthless in discussing nano-sized polymers, their ability to interact with organisms, and the potential for these nano-polymers to cause environmental damage in the marine environment. This review details the breakdown of macro-, micro-, and nano-polymer contamination, examining the sources, the interactions, and the fates of all of these polymer sizes in the environment. The main focus of this review is to perform a comprehensive examination of the literature of the interaction of nanoplastics with organisms, soils, and waters; followed by the discussion of toxicological issues. A significant focus of the review is also on current analytical characterisation techniques for nanoplastics, which will enable researchers to develop protocols for nanopolymer analysis and enhance understanding of nanoplastics in the marine environment.

The Prevalence of Delirium in An Older Acute Surgical Population and Its Effect on Outcome.

BACKGROUND: With an ageing population, an increasing number of older adults are admitted for assessment to acute surgical units. Older adults have specific factors that may influence outcomes, one of which is delirium (acute cognitive impairment). OBJECTIVES: To establish the prevalence of delirium on admission in an older acute surgical population and its effect on mortality. Secondary outcomes investigated include hospital readmission and length of hospital stay. METHOD: This observational multi-centre study investigated consecutive patients, ≥65 years, admitted to the acute surgical units of five UK hospitals during an eight-week period. On admission the Confusion Assessment Method (CAM) score was performed to detect delirium. The effect of delirium on important clinical outcomes was investigated using tests of association and logistic regression models. RESULTS: The cohort consisted of 411 patients with a mean age of 77.3 years (SD 8.1). The prevalence of admission delirium was 8.8% (95% CI 6.2-11.9%) and cognitive impairment was 70.3% (95% CI 65.6-74.7%). The delirious group were not more likely to die at 30 or 90 days (OR 1.1, 95% CI 0.2 to 5.1, p = 0.67; OR 1.4, 95% CI 0.4 to 4.1. p = 0.82) or to be readmitted within 30 days of discharge (OR 0.9, 95% CI 0.4 to 2.2, p = 0.89). Length of hospital stay was significantly longer in the delirious group (median 8 vs. 5 days respectively, p = 0.009). CONCLUSION: Admission delirium occurs in just under 10% of older people admitted to acute surgical units, resulting in significantly longer hospital stays.

Emergency department visits by pediatric patients sustained as a passenger on a motorcycle.

OBJECTIVE: Currently only 5 out of the 50 states in the United States have laws restricting the age of passengers permitted to ride on a motorcycle. This study sought to characterize the visits by patients under the age of 16 to U.S. emergency departments (EDs) for injuries sustained as a passenger on a motorcycle. METHODS: In this retrospective cohort study, data were obtained from the Nationwide Emergency Department Sample (NEDS) for the years 2006 to 2011. Pediatric patients who were passengers on a motorcycle that was involved in a crash were identified using International Classification of Diseases, Ninth Revision (ICD-9) External Cause of Injury codes. We also examined gender, age, disposition, regional differences, common injuries, and charges. RESULTS: Between 2006 and 2011 there were an estimated 9,689 visits to U.S. EDs by patients under the age of 16 who were passengers on a motorcycle involved in a crash. The overall average patient age was 9.4 years, and they were predominately male (54.5%). The majority (85%) of these patients were treated and released. The average charges for discharged patients were $2,116.50 and amounted to roughly $17,500,000 during the 6 years. The average cost for admission was $51,446 per patient and totaled over $54 million. The most common primary injuries included superficial contusions; sprains and strains; upper limb fractures; open wounds of head, neck, and trunk; and intracranial injuries. CONCLUSION: Although there were only about 9,700 visits to U.S. EDs for motorcycle crashes involving passengers less than 16 years old for 2006 to 2011, the total cost of visits that resulted in either ED discharge or hospital admission amounted to over $71 million.

Is anemia associated with cognitive impairment and delirium among older acute surgical patients?

AIM: The determinants of cognitive impairment and delirium during acute illness are poorly understood, despite being common among older people. Anemia is common in older people, and there is ongoing debate regarding the association between anemia, cognitive impairment and delirium, primarily in non-surgical patients. METHODS: Using data from the Older Persons Surgical Outcomes Collaboration 2013 and 2014 audit cycles, we examined the association between anemia and cognitive outcomes in patients aged ≥65 years admitted to five UK acute surgical units. On admission, the Confusion Assessment Method was carried out to detect delirium. Cognition was assessed using the Montreal Cognitive Assessment, and two levels of impairment were defined as Montreal Cognitive Assessment <26 and <20. Logistic regression models were constructed to examine these associations in all participants, and individuals aged ≥75 years only. RESULTS: A total of 653 patients, with a median age of 76.5 years (interquartile range 73.0-80.0 years) and 53% women, were included. Statistically significant associations were found between anemia and age; polypharmacy; hyperglycemia; and hypoalbuminemia. There was no association between anemia and cognitive impairment or delirium. The adjusted odds ratios of cognitive impairment were 0.95 (95% CI 0.56-1.61) and 1.00 (95% CI 0.61-1.64) for the Montreal Cognitive Assessment <26 and <20, respectively. The adjusted odds ratio of delirium was 1.00 (95% CI 0.48-2.10) in patients with anemia compared with those without. Similar results were observed for the ≥75 years age group. CONCLUSIONS: There was no association between anemia and cognitive outcomes among older people in this acute surgical setting. Considering the retrospective nature of the study and possible lack of power, findings should be taken with caution. Geriatr Gerontol Int 2018; 18: 1025-1030.

Pillars of Life: Is There a Relationship between Lifestyle Factors and the Surface Characteristics of Dragonfly Wings?

Dragonfly wings are of great interest to researchers investigating biomimetic designs for antiwetting and antibacterial surfaces. The waxy epicuticular layer on the membrane of dragonfly wings possesses a unique surface nanoarchitecture that consists of irregular arrays of nanoscale pillars. This architecture confers superhydrophobic, self-cleaning, antiwetting, and antibiofouling behaviors. There is some evidence available that suggests that lifestyle factors may have influenced the evolution of the wing nanostructures and, therefore, the resulting properties of the wings; however, it appears that no systematic studies have been performed that have compared the wing surface features across a range of dragonfly species. Here, we provided a comparison of relevant wing surface characteristics, including chemical composition, wettability, and nanoarchitecture, of seven species of dragonfly from three families including Libellulidae, Aeshnidae, and Gomphidae. The characteristic nanopillar arrays were found to be present, and the chemical composition and the resultant wing surface superhydrophobicity were found to be well-conserved across all of the species studied. However, subtle differences were observed between the height, width, and density of nanofeatures and water droplet bouncing behavior on the wing surfaces. The results of this research will contribute to an understanding of the physical and chemical surface features that are optimal for the design of antiwetting and antibacterial surfaces.

Role of a medical student: patient perspectives.

BACKGROUND: Medical students form an important part of the medical team; however, patients may not be fully aware of their role. Identifying students in the clinical setting is difficult because of their similar attire to other health care professionals. This parity may introduce unethical scenarios where patients may be speaking and consenting to individuals whom they do not recognise as students. METHODS: A single-sided questionnaire was given to hospital in-patients during a 12-week period. Questions focused on the role of students. With their opinions, patients were given a list of clinical skills and asked whether or not they would allow a student to carry out these skills on themselves. The list included both required and non-required clinical skills by the General Medical Council (GMC). RESULTS: In total, 101 patients participated in the study: 34 males and 67 females. Age at admittance was 63.4 ± 18.0 years; 74.3 per cent of patients were able to identify a student, although 87.1 per cent believed that students should have a designated uniform. Patients were significantly more likely to allow a student to perform required skills on them, as opposed to non-required skills (p < 0.0001); however, previous contact with a medical student made no difference in the likelihood of consenting to a skill being performed. Identifying students in the clinical setting is difficult CONCLUSIONS: The apparent trade-off between patient safety and providing students with learning opportunities has been of long standing concern. Patients consider GMC-required skills as largely appropriate; however, patients feel that students should be more identifiable, and increasing the awareness of the role and capabilities of a student in patient care is important.

Addressing childhood obesity at school entry: Qualitative experiences of school health professionals.

School entry provides an opportune moment for health professionals to intervene with children who are overweight, yet identification and management of childhood obesity presents challenges in practice. This multi-method qualitative study explored the experiences of 26 school health professionals in addressing childhood obesity at school entry. Methods included semi-structured interviews with service managers (n = 3); focus groups with school nurses (n = 12) and child health practitioners (n = 6); and open-ended questionnaires with school nurses (n = 4) and child health practitioners (n = 1) who were unable to attend the focus groups. A thematic analysis revealed agreement between service managers, school nurses and child health practitioners. Whilst it was felt school health professionals have an important role to play in managing childhood obesity, efforts to address child weight were limited by a lack of capacity, lack of clear protocols, challenges of engaging parents and insufficient training in childhood obesity and related lifestyle issues. School health policymakers need to recognize childhood obesity as a serious public health issue, allocate appropriate resources to nurse training and development and ensure clear pathways are established to ensure consistency of care.

Service evaluation of the GOALS family-based childhood obesity treatment intervention during the first 3†years of implementation.

OBJECTIVES: To evaluate the impact of the GOALS (Getting Our Active Lifestyles Started) family-based childhood obesity treatment intervention during the first 3 years of implementation. DESIGN: Single-group repeated measures with qualitative questionnaires. SETTING: Community venues in a socioeconomically deprived, urban location in the North-West of England. PARTICIPANTS: 70 overweight or obese children (mean age 10.5 years, 46% boys) and their parents/carers who completed GOALS between September 2006 and March 2009. INTERVENTIONS: GOALS was a childhood obesity treatment intervention that drew on social cognitive theory to promote whole family lifestyle change. Sessions covered physical activity (PA), diet and behaviour change over 18 2 h weekly group sessions (lasting approximately 6 months). A Template for Intervention Description and Replication (TIDieR) checklist of intervention components is provided. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was child body mass index (BMI) z-score, collected at baseline, post-intervention and 12 months. Secondary outcome measures were child self-perceptions, parent/carer BMI and qualitative changes in family diet and PA (parent/carer questionnaire). RESULTS: Child BMI z-score reduced by 0.07 from baseline to post-intervention (p<0.001) and was maintained at 12 months (p<0.05). There was no change in parent/carer BMI or child self-perceptions, other than an increase in perceived social acceptance from baseline to post-intervention (p<0.05). Parents/carers reported positive changes to family PA and dietary behaviours after completing GOALS. CONCLUSIONS: GOALS completion was associated with small improvements in child BMI z-score and improved family PA and dietary behaviours. Several intervention modifications were necessary during the implementation period and it is suggested childhood obesity treatment interventions need time to embed before a definitive evaluation is conducted. Researchers are urged to use the TIDieR checklist to ensure transparent reporting of interventions and facilitate the translation of evidence to practice.

Agency and communion attributes in adults' spontaneous self-representations.

This study investigated agency and communion attributes in adults' spontaneous self-representations. The study sample consisted of 158 adults (80 men, 78 women) ranging in age from 20 to 88 years. Consistent with theorising, significant age and sex differences were found in terms of the number of agency and communion attributes. Young and middle-aged adults included significantly more agency attributes in their self-representations than older adults; men listed significantly more agency attributes than women. In contrast, older adults included significantly more communion attributes in their self-representations than young adults, and women listed significantly more communion attributes than men. Significant Age Group x Self-Portrait Display and Sex x Self-Portrait Display interactions were found for communion attributes, indicating that the importance of communion attributes differed across age groups and by sex. Correlational analyses showed significant associations of agency and communion attributes with personality traits and defence mechanisms. Communion attributes also showed significant correlations with four dimensions of psychological well-being.