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Negative outcomes occur early among geriatric patients with early signs of dysphagia in an acute care setting
No full textObjectives: This study aimed to investigate the clinical outcomes associated with early signs of dysphagia (SD) in geriatric patients in an acute care setting. Methods: In this prospective observational study with 18 mo follow-up, geriatric patients were screened for early signs of dysphagia in an acute care setting. Included patients were grouped based on swallowing function—SD or normal swallowing (NS). Follow-up data were retrieved from medical records on 332 patients with complete screening from baseline to 18 mo after admission. Results: Among participants, 52.0% were male, median age was 79 (25th percentile 73.0; 75th percentile 85.0) y and median BMI was 26.1 (22.4;29.8) kg/m 2. Patients with early SD had higher mortality (41.3%) compared with NS (23.3%) (P < 0.001). Both mortality and readmissions occurred within the first 90 d after screening compared with after 90 d. Using multiple hazard regression analyses, risk factors for mortality were identified as increasing age, SD, nutritional risk, low performance status, increasing number of comorbidities, and inflammation markers (P < 0.05). Furthermore, low performance status, a high number of comorbidities, and low hemoglobin were risk factors for readmissions within the 18 mo follow-up period (P < 0.05). Conclusions: Early SD were associated with mortality after 18 mo, but readmissions were mostly pronounced within 90 d. Early dysphagia screening in older patients in general is relevant in the acute care setting as part of nursing care activities.</p
Adaptive Ensemble Control for Stochastic Systems With Mixed Asymmetric Laplace Noises
No full textThis article presents an adaptive ensemble control for stochastic systems subject to asymmetric noises and outliers. Asymmetric noises skew system observations, and outliers with large amplitude deteriorate the observations even further. Such disturbances induce poor system estimation and degraded stochastic system control. In this work, we model the asymmetric noises and outliers by mixed asymmetric Laplace distributions (ALDs) and propose an optimal control for stochastic systems with mixed ALD noises. Particularly, we segregate the system disturbed by mixed ALD noises into subsystems, each of which is subject to a specific ALD noise. For each subsystem, we design an iterative quantile filter (IQF) to estimate the system parameters using system observations. With the estimated parameters by the IQF, we derive the certainty equivalence (CE) control law for each subsystem. Then we use the Bayesian approach to ensemble the subsystem CE controllers, with each of the controllers weighted by its posterior probability. We finalize our control law as the weighted sum of the control signals by the subsystem CE controllers. To demonstrate our approach, we conduct three numerical simulations and Monte Carlo analyses. The results show improved tracking performance by our approach for skew noises and its robustness to outliers, compared with the RLS-based control policy.</p
Sentenced to Social Work: Forensic Intellectual Disability Services in (and Across) Denmark and Kalaallit Nunaat - challenges and possibilities
No full textTowards effective decision support for structural design and risk management:An information-dependent probabilistic system representation enhanced with support vector machine and unfair sampling
No full textStructural design and risk management typically involve uncertainties related to structural performance and loading conditions, which must be effectively managed to ensure compliance with safety requirements. Additionally, the relationships among parameters influencing structural performance are often complex and not easily discernible, thereby complicating the decision-making process. To address these challenges, this paper proposes a decision support framework based on the concept of information-dependent probabilistic system representation. The framework aims to identify unacceptable design parameters in structural design and enhance risk management by updating probabilistic models of uncertain parameters for similar structures when new observational information becomes available. To overcome the computational challenges of structural reliability analysis, a support vector machine (SVM) is employed as a surrogate model for the finite element analysis typically used to evaluate the performance of engineering structures. Additionally, to handle the imbalance issue in the SVM training dataset, an unfair sampling method is introduced. An illustrative example involving a reinforced concrete structure subjected to earthquake loading is presented to demonstrate the effectiveness of the proposed framework.</p
The suitability of fermenter liquor from MSW as an electron donor for hypersaline sulfate reduction
Get PDFLiquor from the fermentation of the organic fraction of municipal solid waste (OFMSW) was tested as a carbon source for sulfate reducing organisms under saline to hypersaline conditions for treating acid mine drainage in arid climates. Two 1.4 L reactors were operated continuously, one as a control maintained at a salinity of 20 g NaCl/L, the other (the test reactor) operated at salinities up to 50 g NaCl/L. Both reactors were first fed a synthetic mix of VFAs (acetate, propionate, butyrate, and valerate) at a COD ratio of 2:1:3:0.5 and at an organic loading rate of 1.56 gCOD/L/d with sulfate supplied in excess as Na2SO4. The sulfate reduction rate (SRR) was unaffected by the salinity up to 35 g NaCl/L, but was adversely affected in hypersaline (>35 g NaCl/L) conditions. The stabilized SRR at 50 g NaCl/L was 0.43 ± 0.01 g SO4-S/L/d compared to 0.66 ± 0.01 g SO4-S/L/d in the control reactor. Upon replacing the VFA mixture in both reactors with fermenter liquor (a mixture of alcohols, VFAs, lactate and succinate and 29 ± 4 % of unidentified COD), at the same COD loading rate, the SRR recovered in the test reactor (50 g NaCl/L) to 0.56 ± 0.01 g SO4-S/L/d with full utilisation of acetate by completely oxidizing sulfate reducers, no methane production and over 65 % utilisation of the un-identified COD fraction.</p
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No full textDanish Migration and refugee law. Danish Aliens Act. 1951 Refugee Conventio
Genotype-by-environment interactions for mean performance and trait variation in house fly larvae reared on two diets
No full textSome insect species have been proposed as a sustainable alternative to traditional animal-based food and feed sources. Optimisation of insect production can generally be achieved using two main approaches: optimising environmental conditions and improving traits of interest through selective breeding. These avenues are not inseparable as performance of a genotype might differ between environments due to phenotypic plasticity and because genotypes can respond differently to environmental changes, that is genotype-by-environment interactions (G × E). In insect production, diets can be of variable quality and consist of waste- and by-products of low nutritional value, which might result in decreased performance and/or increased trait variability within a population. Therefore, it is of interest to investigate how genotypes perform across various diets. Here, we investigated plasticity and G × E for mean performance and trait variation, which we define as the ability of a genotype to produce consistent phenotypes within and across environments. We did this by rearing 190 full-sib families of house fly larvae, Musca domestica L. (Diptera: Muscidae), on two diets based on either alfalfa, Medicago sativa L. (Fabales: Fabaceae), or deproteinated grass. Four larval traits were assessed: egg-to-larva viability, surface area, dry weight and relative lipid content. Reaction norms were used to investigate the effects of diet on full-sib family mean and trait variation within and across environments. We found that families reared on the grass-based diet had higher performance across all investigated traits than families reared on the alfalfa-based diet. For both mean performance and trait variation, we found G × E for all investigated traits. These findings suggest that there is genetic variation for plasticity (slope of reaction norms) for both trait mean and trait variation, and thus that there is a potential to breed for genotypes with high performance as well as for genotypes with low trait variation within and across diets.</p