10 research outputs found
Cardiac autonomic function in adults born preterm with very low birth weight in mid-adulthood-A two-country birth cohort study
No full textAbstract
Cardiac autonomic functioning is altered in children and young adults born preterm with very low birth weight (VLBW; <1500 g). Whether these alterations persist into mid-adulthood remains unknown. We studied heart rate variability (HRV) in two birth cohorts, HeSVA (Finland) and NTNU LBW Life (Norway), with harmonized methods. HRV was assessed in 107 adults born preterm with VLBW and 142 controls born term with normal birth weight at a mean age of 36 (SD 3.3) years. We hypothesized that adults born preterm with VLBW have lower parasympathetic activity and higher blood pressure (BP), partly mediated by lower parasympathetic activity. Participants born preterm with VLBW had higher heart rate and BP than controls. In sex-stratified analyses, mean differences in high-frequency (HF) power were −43.3% (95% CI −63.9%, −11.3%) in women and −36.9% (−65.0%, 15.0%) in men. For root mean square of successive differences, differences were −18.2% (−35.6%, 4.1%) in women and 18.5% (−10.4%, 58.4%) in men. Low-frequency (LF) power differed by −23.7% (−46.2%, 10.5%) in women and 35.0% (−16.5%, 120.3%) in men. LF/HF ratio was 36.3% (4.1%, 76.8%) higher in women and −13.9% (−34.3%, 12.7%) in men. Among women, elevated BP was partly mediated by HRV. Findings suggest altered autonomic regulation in adults born preterm with VLBW, especially women, potentially contributing to higher BP.Abstract
Cardiac autonomic functioning is altered in children and young adults born preterm with very low birth weight (VLBW; <1500 g). Whether these alterations persist into mid-adulthood remains unknown. We studied heart rate variability (HRV) in two birth cohorts, HeSVA (Finland) and NTNU LBW Life (Norway), with harmonized methods. HRV was assessed in 107 adults born preterm with VLBW and 142 controls born term with normal birth weight at a mean age of 36 (SD 3.3) years. We hypothesized that adults born preterm with VLBW have lower parasympathetic activity and higher blood pressure (BP), partly mediated by lower parasympathetic activity. Participants born preterm with VLBW had higher heart rate and BP than controls. In sex-stratified analyses, mean differences in high-frequency (HF) power were −43.3% (95% CI −63.9%, −11.3%) in women and −36.9% (−65.0%, 15.0%) in men. For root mean square of successive differences, differences were −18.2% (−35.6%, 4.1%) in women and 18.5% (−10.4%, 58.4%) in men. Low-frequency (LF) power differed by −23.7% (−46.2%, 10.5%) in women and 35.0% (−16.5%, 120.3%) in men. LF/HF ratio was 36.3% (4.1%, 76.8%) higher in women and −13.9% (−34.3%, 12.7%) in men. Among women, elevated BP was partly mediated by HRV. Findings suggest altered autonomic regulation in adults born preterm with VLBW, especially women, potentially contributing to higher BP
Prognostic factors for outcomes of idiopathic sudden sensorineural hearing loss: protocol for the SeaSHeL national prospective cohort study
No full textINTRODUCTION: The mainstay of treatment for idiopathic sudden sensorineural hearing loss (SSNHL) includes oral steroids, intratympanic steroid injections or a combination of both. The National Institute for Health and Care Excellence, in their recent hearing loss guidelines, highlighted the paucity of evidence assessing the comparative effectiveness of these treatments; and the National Institute for Health Research (NIHR) Health Technology Assessment Programme has since released a commissioned call for a trial to identify the most effective route of administration of steroids as a first-line treatment for idiopathic SSNHL. For such trials to be run effectively, reliable information is needed on patients with SSNHL: where they present, numbers, demographics, treatment pathways, as well as outcomes. This study will collect these data in a nationwide cohort study of patients presenting with SSNHL across 97 National Health Service (NHS) trusts. The study will be delivered through ear, nose and throat (ENT) trainee networks, the NIHR Clinical Research Network (CRN) Audiology Champions and the NIHR CRN. Importantly, this study will also provide a dataset to develop a prognostic model to predict recovery for patients with idiopathic SSNHL. The study objectives are to: (1) map the patient pathway and identify the characteristics of adult patients presenting to NHS ENT and hearing services with SSNHL, (2) develop a prognostic model to predict recovery for patients with idiopathic SSNHL and (3) establish the impact of idiopathic SSNHL on patients' quality of life (QoL). METHODS AND ANALYSIS: Study design: national multicentre prospective cohort study across 97 NHS trusts. INCLUSION CRITERIA: adult patients presenting to NHS ENT and hearing services with SSNHL. OUTCOMES: change in auditory function; change in QoL score. ANALYSIS: multivariable prognostic model, using prespecified candidate predictors. Mean change in QoL scores will be calculated from initial presentation to follow-up. ETHICS AND DISSEMINATION: Health Research Authority and NHS Research Ethics Committee approved the study. Publication will be on behalf of study sites and collaborators. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT04108598)
Learning to see the Ebbinghaus illusion in the periphery reveals a top-down stabilization of size perception across the visual field
No full textInternational audienceOur conscious visual perception relies on predictive signals, notably in the periphery where sensory uncertainty is high. We investigated how such signals could support perceptual stability of objects' size across the visual field. When attended carefully, the same object appears slightly smaller in the periphery compared to the fovea. Could this perceptual difference be encoded as a strong prior to predict the peripheral perceived size relative to the fovea? Recent studies emphasized the role of foveal information in defining peripheral size percepts. However, they could not disentangle bottom-up from top-down mechanisms. Here, we revealed a pure top-down contribution to the perceptual size difference between periphery and fovea. First, we discovered a novel Ebbinghaus illusion effect, inducing a typical reduction of foveal perceived size, but a reversed increase effect in the periphery. The resulting illusory size percept was similar at both locations, deviating from the classic perceptual difference. Then through an updating process of successive peripheral-foveal viewing, the unusual peripheral perceived size decreased. The classic perceptual eccentricity difference was restored and the peripheral illusion effect changed into a fovea-like reduction. Therefore, we report the existence of a prior that actively shapes peripheral size perception and stabilizes it relative to the fovea
Bioactive Chemical Constituents And Biotechnological Production Of Secondary Metabolites In Amaranthaceae Plants, Gomphreneae Tribe
No full textThe Amaranthaceae family comprises of many species, which are used in nutrition and in traditional folk medicine for the treatment of several diseases such as infections, inflammation and fever. Gomphrena, Pfaffia and Alternanthera species are used in the extraction of natural pigments such as betaxanthin and betalains for application as food colorants and antioxidants. Pfaffia paniculata (Brazilian ginseng or Suma) has been indicated as a tonic, as well as having aphrodisiac, analgesic, and antidiabetic properties and may act against cancer. Gomphreneae is the major tribe of Amaranthaceae and previous chemical analyses have demonstrated the occurrence of anthraquinones, aurone, betacyanins, betaxanthins, betalains, chromoalkaloids, ecdysteroids, flavonoids, protoalkaloids, saponins, steroids and triterpenes. Biotechnological investigation with Amaranthaceae plants from the Gomphreneae tribe, demonstrated their potential for bioprospection of bioactive natural compounds such as flavonoids, steroids, terpenoides and saponins. Plant cell cultures, nowadays, are an important strategy for bioprospection of natural products. The in vitro large-scale production of bioactive compounds or extracts used as phytotherapics, pharmaceutical products, food additives and cosmetics should be encouraged because of their scientific, economical or ecological importance. Therefore, the present chapter reviews the literature data of the bioactive chemical constituents and biotechnological production of secondary metabolites in Amaranthaceae plants (Gomphreneae tribe), species that have many pharmacological properties and other applications. © 2012 Bentham Science Publishers. 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Visitors' satisfaction with heritage sites in New Zealand: Causes and complexities, clusters and causes
No full textThe thesis presents findings from a survey of over 1,000 visitors at three New Zealand heritage sites. These sites were Te Puia, the Rotorua Bathhouse Museum and the Rangiriri Battlefield Interpretation Centre. All three represent a key period in New Zealand’s history from the period of approximately 1840 to 1900, but in the case of Te Puia there is also a continuing contemporary cultural importance. This last site, located in Rotorua, was founded as the Maori Arts and Crafts Institute and was established to perpetuate Maori tradition skills in areas such as carving and weaving. Its location was in part determined by the volcanic nature of the valley, long inhabited by members of Te Arawa tribal people. The site has a strong connection with tourism as Te Arawa have entertained tourists from the mid-nineteenth century in the volcanic area. The site therefore represents a tourism site from the perspective of history, culture and natural heritage. The Bathhouse Museum represents a period of late colonial architecture while the third site, the Rangiriri Battlefield is based on the remnants of the Pa (Maori fortifications) that was the site of a battle between the colonial government forces and the Maori Kingi movement on November 23rd 1840.
The motive for the research was to provide a profile of visitors for the respective sites and their management, and then to assess to what degree socio-demographics might be explanatory variables in determining future visitation. The core theories being employed revolved around concepts of levels of interest in heritage and historic sites, the intellectual search for knowledge, and the degree to which people became involved in the activity of heritage site visitation. The work was driven by the finding that only about 11 per cent of visits to cultural tourism sites were ‘purposeful’ tourists as defined by McKercher and Du Cros (2002). Being purposeful implies having specific degrees of interest, of becoming involved and possibly seeking meanings that implied senses of identity. That is, self-awareness accrued from having a better understanding of the past as a means of knowing about the present. This conceptualisation implies use of the theories of involvement, benefits and self-awareness, and the managerial aspects of interpretation. Normally such an approach has been seen by many researchers as a determinant of satisfaction, but in this thesis satisfaction is not seen as simply an end to a process. Rather, this thesis argues that to be satisfied entails not only cognitive and affective components, but also the conative. That conative component can include making recommendations to others, making visits to other heritage sites, or joining organisations associated with heritage sites such as the New Zealand Historic Place Trust. These form key themes in the literature review.
Unfortunately, while these premises emerged from the literature review and informed the hypotheses that are later described in the thesis, they were not wholly supported by the data. It is suggested that one reason for this, from a statistical perspective, was that measures used were subject to multi-collinearity and auto-correlation – put simply, many of the variables are not independent from each other. For example, it is suggested that satisfaction is actually enhanced by subsequently being able to make recommendations to friends and others; that the act of making a recommendation enhances one’s own self in both the eyes of that friend or through an enhanced self- perception of being helpful, and thus auto-correlation may exist between these variables.
This realisation thus leads, in the conclusions of Chapter Eight, to new suggestions for potential future researchers concerning ways of looking at the nature of involvement that draw on distinctions between situational and enduring involvement. Finally, it also needs to be noted that tourists are not lay historians, but are the makers of their holidays, and hence the debate is contextualised within the act of being on holiday, which itself is a period of escape and relaxation for many. Hence the relationships being examined in this thesis are complex, interactive and yet rewarding to untangle
Validation of the OAKS prognostic model for acute kidney injury after gastrointestinal surgery
No full text© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.Background: Postoperative acute kidney injury (AKI) is a common complication of major gastrointestinal surgery with an impact on short- and long-term survival. No validated system for risk stratification exists for this patient group. This study aimed to validate externally a prognostic model for AKI after major gastrointestinal surgery in two multicentre cohort studies. Methods: The Outcomes After Kidney injury in Surgery (OAKS) prognostic model was developed to predict risk of AKI in the 7 days after surgery using six routine datapoints (age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker). Validation was performed within two independent cohorts: a prospective multicentre, international study (‘IMAGINE’) of patients undergoing elective colorectal surgery (2018); and a retrospective regional cohort study (‘Tayside’) in major abdominal surgery (2011–2015). Multivariable logistic regression was used to predict risk of AKI, with multiple imputation used to account for data missing at random. Prognostic accuracy was assessed for patients at high risk (greater than 20 per cent) of postoperative AKI. Results: In the validation cohorts, 12.9 per cent of patients (661 of 5106) in IMAGINE and 14.7 per cent (106 of 719 patients) in Tayside developed 7-day postoperative AKI. Using the OAKS model, 558 patients (9.6 per cent) were classified as high risk. Less than 10 per cent of patients classified as low-risk developed AKI in either cohort (negative predictive value greater than 0.9). Upon external validation, the OAKS model retained an area under the receiver operating characteristic (AUC) curve of range 0.655–0.681 (Tayside 95 per cent c.i. 0.596 to 0.714; IMAGINE 95 per cent c.i. 0.659 to 0.703), sensitivity values range 0.323–0.352 (IMAGINE 95 per cent c.i. 0.281 to 0.368; Tayside 95 per cent c.i. 0.253 to 0.461), and specificity range 0.881–0.890 (Tayside 95 per cent c.i. 0.853 to 0.905; IMAGINE 95 per cent c.i. 0.881 to 0.899). Conclusion: The OAKS prognostic model can identify patients who are not at high risk of postoperative AKI after gastrointestinal surgery with high specificity
The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer – a multicentre observational study
No full textObjective: To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods: This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results: Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions: A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer
Safety of hospital discharge before return of bowel function after elective colorectal surgery
No full textBackground: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients
Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study
No full textAim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56–1.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion
Servicios ecosistémicos en áreas de montaña: beneficios y amenazas
No full textMountain areas have a substantial impact on climate dynamics and are one of the most critical water sources. Mountains were key in human evolution throughout history and supplied essential biotic and abiotic ecosystem services (ES), key for human living. This perspective article will study the importance of mountains to ES supply and the impacts of the different drivers of change, namely habitat change, climate change, overexploitation, pollution, and invasive species. Mountain areas have a high capacity to supply an important number of regulating (global and local climate regulation, air quality regulation, natural hazards regulation, pollination), provisioning (crops, livestock, wild food and fish, biomass for energy and timber, freshwater renewable energy - hydropower, wind, solar and geothermal - and mineral resources) and cultural (recreation and tourism, landscape aesthetics and inspiration, cultural heritage and cultural diversity and knowledge systems). However, changes imposed by habitat change, climate change, overexploitation, pollution, and invasive species can increase the tradeoffs between ES and trigger environmental degradation. Overall, there is a need to balance mountain ES exploitation and reduce the effects of the different drivers of change.Las áreas de montaña tienen un impacto importante en las dinámicas climáticas y son una de las fuentes de agua con condiciones más críticas. Las montañas fueron claves en la evolución histórica del ser humano y suministraron servicios ecosistémicos (SE) bióticos y abióticos esenciales para la vida humana. Este artículo de perspectiva estudiará la importancia de las montañas para el suministro de SE y los impactos de los diferentes factores de cambio, a saber, cambios en el hábitat, el cambio climático, la sobreexplotación, la contaminación y las especies invasoras. Las zonas de montaña tienen una gran capacidad para suministrar un número importante de recursos reguladores (regulación del clima global y local, regulación de la calidad del aire, regulación de los riesgos naturales, polinización), de aprovisionamiento (cultivos, ganado, alimentos y pesca silvestre, biomasa para energía y madera, energía renovable de agua dulce -hidroeléctrica, eólica, solar y geotérmica- y recursos minerales) y culturales (ocio y turismo, estética e inspiración del paisaje, patrimonio cultural y diversidad cultural y sistemas de conocimiento). Sin embargo, los cambios impuestos por la modificación del hábitat, el cambio climático, la sobreexplotación, la contaminación y las especies invasoras pueden aumentar los intercambios entre los SE y desencadenar la degradación del medio ambiente. En general, es necesario equilibrar la utilización de los SE de montaña y reducir los efectos de los distintos factores de cambio
