Specific food preferences of older adults with a poor appetite. A forced-choice test conducted in various care settings

A poor appetite in older adults is an important determinant of reduced food intake and undernutrition. Food preferences may influence food intake. The aim of this study was to investigate food preferences of older adults with a poor appetite and compare these with preferences of older adults with a good appetite. Older adults (n = 349, aged 65–101 years) in nursing/residential care homes, hospitals or at home receiving home care participated in a computer-based forced-choice food preference assessment. Self-reported appetite in the past week was classified as ‘good’ or ‘poor’ using a validated instrument. Food preferences were determined by counting the relative frequency of choices for food images according to 11 dichotomous categories: high/low 1) protein; 2) fat; 3) carbohydrates; 4) fiber; 5) variation; and 6) animal/vegetarian proteins; 7) sweet/savory taste; 8) solid/liquid texture; 9) dairy/non-dairy; with/without 10) sauce or 11) color variation. Specific food preferences in participants with a poor appetite were identified by one-sample t-tests comparing frequencies to the expected value of 48. Preference differences between those with a good and a poor appetite were analyzed using GLM adjusting for confounders. The results showed that older adults with a poor appetite (n = 113; 32.4%) preferred variation (51.6 vs. 48, P < 0.001), color variation (55.9 vs. 48, P < 0.01), non-dairy (53.0 vs. 48, P < 0.001), high-fiber (51.8 vs. 48, P < 0.05), and solid texture (53.5 vs. 48, P < 0.05). Participants with a poor appetite had a higher frequency score for variation than participants with a good appetite (51.6 vs. 48.5, P < 0.001). In conclusion, older adults with a poor appetite may have specific food preferences. Their preference for variation differs from those with a good appetite. These results may be used to develop meals that are preferred by older adults with poor appetite in order to increase food intake and prevent undernutrition

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Dynamic soil pressures on rigid vertical walls

A critical evaluation is made of the dynamic pressures and the associated forces induced by ground shaking on a rigid, straight, vertical wall retaining a semi-infinite, uniform viscoelastic layer of constant thickness. The effects of both harmonic and earthquake-induced excitations are examined. Simple approximate expressions for the responses of the system are developed, and comprehensive numerical data are presented which elucidate the effects and relative importance of the various parameters involved. These solutions are then compared with those obtained by use of a simple model proposed previously by Scott, and the accuracy of this model is assessed. Finally, two versions of an alternative model are proposed which better approximate the action of the system. In the first, the properties of the model are defined by frequency-dependent parameters, whereas in the second, which is particularly helpful in analyses of transient response, they are represented by frequency-independent, constant parameters

Dynamic soil pressures on rigid cylindrical vaults

A critical evaluation is made of the dynamic pressures and the associated forces induced by ground shaking on an upright, circular, rigid vault that is embedded in a uniform viscoelastic stratum of constant thickness and infinite extent in the horizontal plane. Both the vault and the stratum are presumed to be supported on a non- deformable base undergoing a space-invariant, uniform horizontal motion. The effects of both harmonic and earthquake-induced excitations are examined. Simple approximate expressions for the responses of the system are formulated, and comprehensive numerical data are presented which elucidate the underlying response mechanisms and the effects and relative importance of the various parameters involved. The parameters investigated include the height to radius ratio for the vault, the conditions at the vault-medium interface, and the material properties of the stratum. In addition to valuable insights into the response of the particular system being examined, the results presented provide a conceptual framework for the analysis and interpretation of solutions for more involved systems as well

Advice to purchasers Setting NHS contracts for rehabilitation medicine

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