Identifying and visualising multimorbidity and comorbidity patterns in patients in the English National Health Service: a population-based study

Summary. Background: Globally, there is a paucity of multimorbidity and comorbidity data, especially for minority ethnic groups and younger people. We estimated the frequency of common disease combinations and identified non-random disease associations for all ages in a multiethnic population. Methods In this population-based study, we examined multimorbidity and comorbidity patterns stratified by ethnicity or race, sex, and age for 308 health conditions using electronic health records from individuals included on the Clinical Practice Research Datalink linked with the Hospital Episode Statistics admitted patient care dataset in England. We included individuals who were older than 1 year and who had been registered for at least 1 year in a participating general practice during the study period (between April 1, 2010, and March 31, 2015). We identified the most common combinations of conditions and comorbidities for index conditions. We defined comorbidity as the accumulation of additional conditions to an index condition over an individual's lifetime. We used network analysis to identify conditions that co-occurred more often than expected by chance. We developed online interactive tools to explore multimorbidity and comorbidity patterns overall and by subgroup based on ethnicity, sex, and age. Findings: We collected data for 3 872 451 eligible patients, of whom 1 955 700 (50·5%) were women and girls, 1 916 751 (49·5%) were men and boys, 2 666 234 (68·9%) were White, 155 435 (4·0%) were south Asian, and 98 815 (2·6%) were Black. We found that a higher proportion of boys aged 1–9 years (132 506 [47·8%] of 277 158) had two or more diagnosed conditions than did girls in the same age group (106 982 [40·3%] of 265 179), but more women and girls were diagnosed with multimorbidity than were boys aged 10 years and older and men (1 361 232 [80·5%] of 1 690 521 vs 1 161 308 [70·8%] of 1 639 593). White individuals (2 097 536 [78·7%] of 2 666 234) were more likely to be diagnosed with two or more conditions than were Black (59 339 [60·1%] of 98 815) or south Asian individuals (93 617 [60·2%] of 155 435). Depression commonly co-occurred with anxiety, migraine, obesity, atopic conditions, deafness, soft-tissue disorders, and gastrointestinal disorders across all subgroups. Heart failure often co-occurred with hypertension, atrial fibrillation, osteoarthritis, stable angina, myocardial infarction, chronic kidney disease, type 2 diabetes, and chronic obstructive pulmonary disease. Spinal fractures were most strongly non-randomly associated with malignancy in Black individuals, but with osteoporosis in White individuals. Hypertension was most strongly associated with kidney disorders in those aged 20–29 years, but with dyslipidaemia, obesity, and type 2 diabetes in individuals aged 40 years and older. Breast cancer was associated with different comorbidities in individuals from different ethnic groups. Asthma was associated with different comorbidities between males and females. Bipolar disorder was associated with different comorbidities in younger age groups compared with older age groups. Interpretation: Our findings and interactive online tools are a resource for: patients and their clinicians, to prevent and detect comorbid conditions; research funders and policy makers, to redesign service provision, training priorities, and guideline development; and biomedical researchers and manufacturers of medicines, to provide leads for research into common or sequential pathways of disease and inform the design of clinical trials

Electron energy spectra, fluxes, and day-night asymmetries of boron-8 solar neutrinos from the 391-day salt phase sno data set

Results are reported from the complete salt phase of the Sudbury Neutrino Observatory experiment in which NaCl was dissolved in the D_2O target. The addition of salt enhanced the signal from neutron capture, as compared to the pure D_2O detector. By making a statistical separation of charged-current events from other types based on event-isotropy criteria, the effective electron recoil energy spectrum has been extracted. In units of 106 cm-2 s-1, the total flux of active-flavor neutrinos from 8B decay in the Sun is found to be 4.94+0.21_-0.21(stat)+0.38_-0.34(syst) and the integral flux of electron neutrinos for an undistorted 8B spectrum is 1.68+0.06_-0.06(stat)+0.08_-0.09(syst); the signal from (nu_x,e) elastic scattering is equivalent to an electron-neutrino flux of 2.35+0.22-0.22(stat)+0.15_-0.15(syst). These results are consistent with those expected for neutrino oscillations with the so-called Large Mixing Angle parameters, and also with an undistorted spectrum. A search for matter-enhancement effects in the Earth through a possible day-night asymmetry in the charged-current integral rate is consistent with no asymmetry. Including results from other experiments, the best-fit values for two-neutrino mixing parameters are Delta m2 = (8.0+0.6_-0.4) x 10-5 eV2 and theta = 33.9 +2.4_-2.2 degrees

Recent results from SNO

The SNO project has now completed two of its three major phases of operation. The no-oscillation hypothesis has been ruled out at 5σ in the pure heavy water phase and 8σ in the salt phase. Discussion in terms of the SeeSaw model is presented

Lipolytic enzymes and hydrolytic rancidity

Lipolysis, the enzymic hydrolysis of milk lipids to free fatty acids and partial glycerides, is a constant concern to the dairy industry because of the detrimental effcts it can have on the flvor and other properties of milk and milk products. However, free fatty acids also contribute to the desirable flavor of milk and milk products when present at low concentrations and, in some cheeses, when present at high concentrations. The enzymes responsible for the detrimental effects of lipolysis are of two main types: those indigenous to milk, and those of microbial origin. The major indigenous milk enzyme is lipoprotein lipase. It is active on the fat in natural milk fat globules only after their disruption by physical treatments or if certain blood serum lipoproteins are present. The major microbial lipases are produced by psychrotrophic bacteria. Many of these enzymes are heat stable and are particularly significant in stored products. Human milk differs from cows' milk in that it contains two lipases, a lipoprotein lipase and a bile salt-stimulated lipase. The ability of the latter to cause considerable hydrolysis of ingested milk lipids has important nutritional implications