33659 research outputs found
Sort by
Survival and recovery modeling of acute kidney injury in critically ill adults
Get PDFObjectives: Acute kidney injury is common among the critically ill. However, the incidence, medication use, and outcomes of acute kidney injury have been variably described. We conducted a single-center, retrospective cohort study to examine the risk factors and correlates associated with acute kidney injury in critically ill adults with a particular focus on medication class usage.
Methods: We reviewed the electronic medical records of all adult patients admitted to an intensive care unit between 1 February and 30 August 2020. Acute kidney injury was defined by the 2012 Kidney Disease: Improving Global Outcomes guidelines. Data included were demographics, comorbidities, symptoms, laboratory parameters, interventions, and outcomes. The primary outcome was acute kidney injury incidence. A Least Absolute Shrinkage and Selection Operator regression model was used to determine risk factors associated with acute kidney injury. Secondary outcomes including acute kidney injury recovery and intensive care unit mortality were analyzed using a Cox regression model.
Results: Among 226 admitted patients, 108 (47.8%) experienced acute kidney injury. 37 (34.3%), 39 (36.1%), and 32 patients (29.6%) were classified as acute kidney injury stages I–III, respectively. Among the recovery and mortality cohorts, analgesics/sedatives, anti-infectives, and intravenous fluids were significant (p-value \u3c 0.05). The medication classes IV-fluid electrolytes nutrition (96.7%), gastrointestinal (90.2%), and anti-infectives (81.5%) were associated with an increased odds of developing acute kidney injury, odd ratios: 1.27, 1.71, and 1.70, respectively. Cox regression analyses revealed a significantly increased time-varying mortality risk for acute kidney injury-stage III, hazard ratio: 4.72 (95% confidence interval: 1–22.33). In the recovery cohort, time to acute kidney injury recovery was significantly faster in stage I, hazard ratio: 9.14 (95% confidence interval: 2.14–39.06) cohort when compared to the stage III cohort.
Conclusion: Evaluation of vital signs, laboratory, and medication use data may be useful to determine acute kidney injury risk stratification. The influence of particular medication classes further impacts the risk of developing acute kidney injury, necessitating the importance of examining pharmacotherapeutic regimens for early recognition of renal impairment and prevention
Aquatic Animal Foods for Nutrition Security and Child Health
No full textBackground: Aquatic animal source foods (AASF) can provide vital nutrients and bioactive factors essential for human health, yet disparities in consumption patterns prevail globally. Limited evidence exists for the implications of AASF access on child health outcomes. Objective: This study aimed to examine global AASF intakes longitudinally in association with critical nutrient intakes and childhood stunting and anemia. Methods: The analysis draws from compiled longitudinal country data (1993-2013) based on a constructed conceptual framework encompassing social and ecological factors that influence fish consumption and human health. Longitudinal generalized linear models were used to estimate the association of apparent AASF intake on country-level nutrient availability (docosahexaenoic acid [DHA], choline, vitamin B12, iron, and zinc) and prevalence of undernourishment, child stunting, and child anemia. Results: Across 175 countries, the median per capita daily apparent intake of all AASF was 37.87 g, with marginally significant differences observed between countries with low (46.65 g) versus high child mortality (23.50 g). The combined category of all AASF was significantly associated with increased total apparent intakes of DHA, choline, and vitamin B12 and reduced child stunting. Finfish (pelagic and demersal) and crustaceans inversely correlated with child stunting, while apparent intakes of mollusks and crustaceans were associated with reduced child anemia. Conclusions: This study uniquely showed that AASF were associated with improved child health outcomes and the critical nutrients necessary for growth, development, and maintaining health throughout the life course. Policies should ensure increased access to AASF across food systems and within sustainable healthy diets globally
Incorporating temperature-dependent fish bioenergetics into a Narragansett Bay food web model
No full textFood web models capture shifting species interactions, making them useful tools for exploring community responses to disturbances. The inclusion of environmental drivers, such as temperature, can improve model predictions, as energy demands of an organism can be temperature specific. While mass-balance models such as Ecopath with Ecosim (EwE) and the R implementation, Rpath, have included some thermal responses in past work, models have yet to include temperature-dependent energetic demands and metabolic costs. Our work demonstrates the inclusion of temperature-dependent bioenergetics into an Rpath food web model using the case study of a warming estuary: Narragansett Bay (Rhode Island, U.S.A). Thermal response parameters from literature were used to construct Kitchell curves describing temperature-dependent consumption and modified Arrhenius curves describing temperature-dependent respiration. Surface water temperature time series from 1994 to 2054 for high and low warming scenarios were created using observed temperatures and projections from the Coupled Model Intercomparison Project (CMIP6) multi-model ensemble. The integration of temperature-dependent fish bioenergetics resulted in lower projected biomasses as energetic demands increased. The degree to which biomass was impacted varied by functional group, though piscivorous fishes were particularly affected as both that group and their prey groups had forced bioenergetic changes. The differences in the model-predicted biomasses highlight the importance of accounting for thermal effects on marine species in ecosystem models, which will become increasingly important as ocean temperatures continue to rise in Narragansett Bay and elsewhere
Rubble fields shape planktonic protist communities in Indonesia at a local scale
No full textThe Coral Triangle encompasses nearly 30% of the world\u27s coral reefs and is widely considered the epicenter of marine biodiversity. Destructive fishing practices and natural disturbances common to this region damage reefs leaving behind fields of coral rubble. While the impacts of disturbances in these ecosystems are well documented on metazoans, we have a poor understanding of their impact on microbial communities at the base of the food web. We use metabarcoding to characterize protist community composition in sites of varying fisheries management schemes and benthic profiles across the island of Lombok, Indonesia. Our study shows that rubble coverage and net primary productivity are the strongest explainers of variation in protist communities across Lombok. More specifically, rubble fields are characterized by increases in small heterotrophic protists, including ciliates and cercozoans. In addition to shifts in heterotrophic protist communities, we also observed increases in diatom relative abundance in rubble fields, which corresponded to sites with higher net primary productivity. These results are the first to characterize protist communities in tropical marine rubble fields and provide insight on environmental factors potentially driving these shifts on a local scale
Organic farmers face persistent barriers to adopting diversification practices in California’s Central Coast
Get PDFIn the face of myriad environmental challenges associated with industrial agriculture, some farmers and researchers have looked to diversified farming systems as a promising alternative. Despite well-documented ecological benefits, diversification practices remain rare in many regions of the U.S, even amongst organic farmers. Our study focuses on organic farmers in the Central Coast region of California, an area that has played a crucial role in the rise of organic agriculture over the last several decades. Through 20 interviews with farmers who all grow lettuce and 8 interviews with technical assistance providers, we investigate the persistent barriers that growers in this region face in adopting diversification practices including cover cropping, compost application, crop rotation, insectary strips, and hedgerows. We find that high land rents, the predominance of short-term leases, stringent food safety standards, and other supply chain pressures significantly hamper the adoption of diversification practices. In order to surmount these barriers and increase adoption, solutions must be pursued at three interconnected levels: innovation at the farm level, and policy change at the technical and structural levels. Locally-informed, integrated, and innovative policies across these three levels must be explored to support the creation of a more resilient, sustainable, and equitable food system