Slower Decline in C-Reactive Protein after an Inflammatory Insult Is Associated with Longer Survival in Older Hospitalised Patients

Background Enhancing biological resilience may offer a novel way to prevent and ameliorate disease in older patients. We investigated whether changes in C-reactive protein (CRP), as a dynamic marker of the acute inflammatory response to diverse stressors, may provide a way to operationalize the concept of resilience in older adults. We tested this hypothesis by examining whether such changes could predict prognosis by identifying which individuals are at greater risk of 6-month mortality. Methods Analysis of prospective, routinely collected datasets containing data on hospitalization, clinical chemistry and rehabilitation outcomes for rehabilitation inpatients between 1999 and 2011. Maximum CRP response during acute illness and CRP recovery indices (time and slope of CRP decay to half maximum, and t

Double faecal immunochemical testing in patients with symptoms suspicious of colorectal cancer

Background: Faecal immunochemical test (FIT)-directed pathways based on a single test have been implemented for symptomatic patients. However, with a single test, the sensitivity is 87 per cent at 10 µg haemoglobin (Hb) per g faeces. This aims of this study were to define the diagnostic performance of a single FIT, compared with double FIT in symptomatic populations. Methods: Two sequential prospective patient cohorts referred with symptoms from primary care were studied. Patients in cohort 1 were sent a single FIT, and those in cohort 2 received two tests in succession before investigation. All patients were investigated, regardless of having a positive or negative test (threshold 10 µg Hb per g). Results: In cohort 1, 2260 patients completed one FIT and investigation. The sensitivity of single FIT was 84.1 (95 per cent c.i. 73.3 to 91.8) per cent for colorectal cancer and 67.4 (61.0 to 73.4) per cent for significant bowel pathology. In cohort 2, 3426 patients completed at least one FIT, and 2637 completed both FITs and investigation. The sensitivity of double FIT was 96.6 (90.4 to 99.3) per cent for colorectal cancer and 83.0 (77.4 to 87.8) per cent for significant bowel pathology. The second FIT resulted in a 50.0 per cent reduction in cancers missed by the first FIT, and 30.0 per cent for significant bowel pathology. Correlation between faecal Hb level was only modest (rs = 0.58), and 16.8 per cent of double tests were discordant, 11.4 per cent in patients with colorectal cancer and 18.3 per cent in those with significant bowel pathology. Conclusion: FIT in patients with high-risk symptoms twice in succession reduces missed significant colorectal pathology and has an acceptable workload impact

The effects of ditch dams on water‐level dynamics in tropical peatlands

A significant proportion of tropical peatlands has been drained for agricultural purposes, resulting in severe degradation. Hydrological restoration, which usually involves blocking ditches, is therefore a priority. Nevertheless, the influence of ditch blocking on tropical peatland hydrological functioning is still poorly understood. We studied water-level dynamics using a combination of automated and manual dipwells, and also meteorological data during dry and wet seasons over 6 months at three locations in Sebangau National Park, Kalimantan, Indonesia. The locations were a forested peatland (Forested), a drained peatland with ditch dams (Blocked), and a drained peatland without ditch dams (Drained). In the dry season, water tables at all sites were deeper than the Indonesian regulatory requirement of 40 cm from the peat surface. In the dry season, the ditches were dry and water did not flow to them. The dry season water-table drawdown rates — solely due to evapotranspiration — were 9.3 mm day−1 at Forested, 9.6 mm day−1 at Blocked, but 12.7 mm day−1 at Drained. In the wet season, the proportion of time during which water tables in the wells were deeper than the 40 cm limit ranged between 16% and 87% at Forested, 0% at Blocked, and between 0% and 38% at Drained. In the wet season, water flowed from the peatland to ditches at Blocked and Drained. The interquartile range of hydraulic gradients between the lowest ditch outlet and the farthest well from ditches at Blocked was 3.7 × 10−4 to 7.8 × 10−4 m m−1, but 1.9 × 10−3 to 2.6 × 10−3 m m−1 at Drained. Given the results from Forested, a water-table depth limit policy based on field data may be required, to reflect natural seasonal dynamics in tropical peatlands. Revised spatial designs of dams or bunds are also required, to ensure effective water-table management as part of tropical peatland restoration

Nutritional knowledge, eating behaviour and attitudes during pregnancy in obese and non-obese Scottish women

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