Prognostic Nutritional Index: Its Usefulness as a Predictor of Clinical Course

It is of great consequence to be able to predict an individual\u27s risk of clinical complication during hospitalization. The Prognostic Nutritional Index (PNI), which is based upon one\u27s nutritional status, is a method that has been developed for this purpose. The PNI equation is comprised of the following indicators of nutritional status: serum albumin level, serum transferrin level, triceps skinfold thickness, and delayed hypersensitivity. This study was designed to evaluate the usefulness of PNI in predicting clinical course. The sample was composed of 328 subjects who had been admitted to medical or surgical services of the Veterans Administration Medical Center, Johnson City, Tennessee. The criterion for inclusion in the study was complete nutritional assessment between 1978 and 1981. A PNI was calculated for each subject. Using a retrospective review of subjects\u27 medical records, extent and type of complications was determined. The measure of complication score used in the study could range from 0 - 28. The mean for the PNI was approximately 45%, indicating that, on average, the risk of clinical complications in this sample was 45% or in the intermediate (40-50%) category. This was the equivalent of a complication score of 8. There was a significant (p \u3c 0.05), positive correlation between PNI and complication score. A positive multiple correlation was found between complication score and the block of variables upon which PNI is based, specifically serum albumin level, serum transferrin level, triceps skinfold thickness, and delayed hypersensitivity. These results support a direct relationship between nutritional status and clinical course. This provides documentation for the usefulness of PNI as a technique for predicting clinical complications based upon nutritional assessment

A socio-economic investigation of pre-harvest and post-harvest crop loss between producers and retailers in Fenland

This paper presents the results of an investigation which identified causes of both pre- and post-harvest crop losses and retail-induced crop losses within Fenland, Cambridgeshire. This study used semi-structured face-to-face interviews with local fruit and vegetable producers. Constructivist grounded theory was utilised for data analysis which revealed aspects not previously identified within academic literature. The causes of crop loss are heavily influenced by external forces situated near the consumer-end of the food supply chain in addition to natural factors, such as weather events, were identified to form a small percentage of loss. While crop loss cannot be totally mitigated; producers appear to use a plethora of strategies including the use of technology to minimise these losses. Producers were found to be directly affected by the high demands of retailers and consumers, however, the significance was found to be dependent on the scale of production and the crop grown. This study establishes the need for new future policies to ensure equality for producers in the UK fresh food supply chain, in addition to the promotion of sustainable food production

Therapeutic Interventions for the Treatment of Infants Exposed to Drugs and Alcohol in Utero

Primary Focus (Complete): Children and Youth Learning Objectives (Provide 3 learning objectives): At the conclusion of the session, the learner will be able to: Identify areas of occupational performance that are affected when an infant is born with Neonatal Abstinence Syndrome or Fetal Alcohol Spectrum Disorder. Recognize the importance of therapeutic interventions in promoting healthy development and participation of infants within the scope of practice for occupational therapy. Apply evidence-based occupational therapy interventions for infants with Neonatal Abstinence Syndrome (NAS) or Fetal Alcohol Spectrum Disorders (FASD). Abstract: In the United States, approximately 0.2-1.5 per 1,000 infants are diagnosed with Fetal Alcohol Syndrome (Centers for Disease Control and Prevention, 2016) and 5.8 per 1,000 infants are diagnosed with NAS, indicating a fivefold increase in prevalence since 2000 (National Institute on Drug Abuse, 2015). This increase is problematic in terms of babies’ health and development, longer hospital stays, and greater hospital costs. Infants exposed to substances in utero are at risk for multiple health issues including withdrawal, delays in cognitive, social, physical and language development. Common deficits seen throughout the lifespan are in the areas of attention, learning, memory, executive functioning, abstract reasoning, language, vision, and lower IQ scores. (Trustees of Princeton University - Brookings, n.d.; Paley, & O\u27Connor, 2007). Occupational therapy aims to increase occupational performance and facilitate optimal development of the infant (American Occupational Therapy Association, 2014). An exhaustive literature search was conducted through a systematic review utilizing CINAHL, PubMed and Scopus. Databases were searched to answer the clinical question “what is the evidence for the effectiveness of therapeutic interventions used to improve occupational performance for infants exposed to drugs and alcohol in utero?”. Articles were screened for eligibility and critically reviewed to determine strength and quality of evidence with the following inclusion criteria: infants ages 0-12 months, diagnosis of Neonatal Abstinence Syndrome or Fetal Alcohol Spectrum Disorders, English language and a publication date of ten years or less. This session will present current therapeutic interventions to advance the professional development of clinicians treating this population. Common themes show that rooming-in, breastfeeding, and tactile interventions can potentially mitigate effects of NAS. These interventions showed statistically and clinically significant effects in pharmacological care, hospital length of stay, cost, onset of NAS symptoms, and typical sleep patterns of the infants within the studies. Occupational therapists in the NICU may utilize these techniques for infants under their care. Further research is necessary to assess the occupational performance outcomes of infants when utilizing these interventions in practice. Other: Describe the level of material being presented: Introductory Audience: Licensed Occupational Therapists, Occupational Therapy Assistants, and Occupational Therapy Students References American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. doi:10.5014/ajot.2014.682006 Centers for Disease Control and Prevention (CDC). (2016). Fetal Alcohol Spectrum Disorder: Data and Statistics. Retrieved from http://www.cdc.gov/ncbddd/fasd/data.html National Institute on Drug Abuse. (2015). Dramatic Increases in Maternal Opiate Use and Neonatal Abstinence Syndrome. Retrieved from https://www.drugabuse.gov/related-topics/trendsstatistics/infographics/dramatic-increases-in-maternal-opioid-use-neonatal-abstinence-syndrome Paley, B., & O\u27Connor, M. J. (2007). Neurocognitive and neurobehavioral impairments in individuals with fetal alcohol spectrum disorders: Recognition and assessment. International Journal on Disability and Human Development, 6(2), 127-142. Trustees of Princeton University - Brookings: Providing research and analysis to promote effective policies and programs for children. (n.d.). Retrieved July 26, 2016, from http://www.futureofchildren.org/publications/journals/article/index.xml?journalid=69 Presentation: 42:0

Structural basis of glycerophosphodiester recognition by the Mycobacterium tuberculosis substrate-binding protein UgpB

Mycobacterium tuberculosis (Mtb) is the causative agent of tuberculosis (TB) and has evolved an incredible ability to survive latently within the human host for decades. The Mtb pathogen encodes for a low number of ATP-binding cassette (ABC) importers for the acquisition of carbohydrates that may reflect the nutrient poor environment within the host macrophages. Mtb UgpB (Rv2833) is the substrate binding domain of the UgpABCE transporter that recognises glycerophosphocholine (GPC), indicating that this transporter has a role in recycling glycerophospholipid metabolites. By using a combination of saturation transfer difference (STD) NMR and X-ray crystallography we report the structural analysis of Mtb UgpB complexed with GPC and have identified that Mtb UgpB does not only recognise GPC but that it is promiscuous for a broad range of glycerophosphodiesters. Complementary biochemical analyses and site-directed mutagenesis precisely define the molecular basis and specificity of glycerophosphodiester recognition. Our results provide critical insights into the structural and functional role of the Mtb UgpB transporter and reveal that the specificity of this ABC-transporter is not limited to GPC therefore optimising the ability of Mtb to scavenge scarce nutrients and essential glycerophospholipid metabolites via a single transporter during intracellular infection

Permissive versus restrictive temperature thresholds in critically ill children with fever and infection: A multicentre randomized clinical pilot trial

Background: Fever improves pathogen control at a significant metabolic cost. No randomized clinical trials (RCT) have compared fever treatment thresholds in critically ill children. We performed a pilot RCT to determine whether a definitive trial of a permissive approach to fever in comparison to current restrictive practice is feasible in critically ill children with suspected infection. Methods: An open, parallel-group pilot RCT with embedded mixed methods perspectives study in four UK paediatric intensive care units (PICUs) and associated retrieval services. Participants were emergency PICU admissions aged > 28 days to < 16 years receiving respiratory support and supplemental oxygen. Subjects were randomly assigned to permissive (antipyretic interventions only at ≥ 39.5 °C) or restrictive groups (antipyretic interventions at ≥ 37.5 °C) whilst on respiratory support. Parents were invited to complete a questionnaire or take part in an interview. Focus groups were conducted with staff at each unit. Outcomes were measures of feasibility: recruitment rate, protocol adherence and acceptability, between group separation of temperature and safety. Results: One hundred thirty-eight children met eligibility criteria of whom 100 (72%) were randomized (11.1 patients per month per site) without prior consent (RWPC). Consent to continue in the trial was obtained in 87 cases (87%). The mean maximum temperature (95% confidence interval) over the first 48 h was 38.4 °C (38.2-38.6) in the restrictive group and 38.8 °C (38.6-39.1) in the permissive group, a mean difference of 0.5 °C (0.2-0.8). Protocol deviations were observed in 6.8% (99/1438) of 6-h time periods and largely related to patient comfort in the recovery phase. Length of stay, duration of organ support and mortality were similar between groups. No pre-specified serious adverse events occurred. Staff (n = 48) and parents (n = 60) were supportive of the trial, including RWPC. Suggestions were made to only include invasively ventilated children for the duration of intubation. Conclusion: Uncertainty around the optimal fever threshold for antipyretic intervention is relevant to many emergency PICU admissions. A more permissive approach was associated with a modest increase in mean maximum temperature. A definitive trial should focus on the most seriously ill cases in whom antipyretics are rarely used for their analgesic effects alone. Trial registration: ISRCTN16022198. Registered on 14 August 2017

Bioactive Endophytes Warrant Intensified Exploration and Conservation

A key argument in favor of conserving biodiversity is that as yet undiscovered biodiversity will yield products of great use to humans. However, the link between undiscovered biodiversity and useful products is largely conjectural. Here we provide direct evidence from bioassays of endophytes isolated from tropical plants and bioinformatic analyses that novel biology will indeed yield novel chemistry of potential value.We isolated and cultured 135 endophytic fungi and bacteria from plants collected in Peru. nrDNAs were compared to samples deposited in GenBank to ascertain the genetic novelty of cultured specimens. Ten endophytes were found to be as much as 15–30% different than any sequence in GenBank. Phylogenetic trees, using the most similar sequences in GenBank, were constructed for each endophyte to measure phylogenetic distance. Assays were also conducted on each cultured endophyte to record bioactivity, of which 65 were found to be bioactive.The novelty of our contribution is that we have combined bioinformatic analyses that document the diversity found in environmental samples with culturing and bioassays. These results highlight the hidden hyperdiversity of endophytic fungi and the urgent need to explore and conserve hidden microbial diversity. This study also showcases how undergraduate students can obtain data of great scientific significance

Dilated cardiomyopathy myosin mutants have reduced force-generating capacity

Dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM) can cause arrhythmias, heart failure, and cardiac death. Here, we functionally characterized the motor domains of five DCM-causing mutations in human ?-cardiac myosin. Kinetic analyses of the individual events in the ATPase cycle revealed that each mutation alters different steps in this cycle. For example, different mutations gave enhanced or reduced rate constants of ATP binding, ATP hydrolysis, or ADP release or exhibited altered ATP, ADP, or actin affinity. Local effects dominated, no common pattern accounted for the similar mutant phenotype, and there was no distinct set of changes that distinguished DCM mutations from previously analyzed HCM myosin mutations. That said, using our data to model the complete ATPase contraction cycle revealed additional critical insights. Four of the DCM mutations lowered the duty ratio (the ATPase cycle portion when myosin strongly binds actin) because of reduced occupancy of the force-holding A·M.D complex in the steady-state. Under load, the A·M·D state is predicted to increase owing to a reduced rate constant for ADP release, and this effect was blunted for all five DCM mutations. We observed the opposite effects for two HCM mutations, namely R403Q and R453C. Moreover, the analysis predicted more economical use of ATP by the DCM mutants than by WT and the HCM mutants. Our findings indicate that DCM mutants have a deficit in force generation and force holding capacity due to the reduced occupancy of the force-holding state