Trends in immediate postmastectomy breast reconstruction in the United Kingdom

The study aimed to evaluate local and national trends in immediate breast reconstruction (IBR) using the national English administrative records, Hospital Episode Statistics. Our prediction was an increase in implant-only and free flap procedures and a decline in latissimus flap reconstructions.Data from an oncoplastic center were interrogated to derive numbers of implant-only, autologous latissimus dorsi (LD), LD-assisted, and autologous pedicled or free flap IBR procedures performed between 2004 and 2013. Similarly, Hospital Episode Statistics data were used to quantify national trends in these procedures from 1996 to 2012 using a curve fitting analysis.National data suggest an increase in LD procedures between 1996 (n = 250) and 2002 (n = 958), a gradual rise until 2008 (n = 1398) followed by a decline until 2012 (n = 1090). As a percentage of total IBR, trends in LD flap reconstruction better fit a quadratic (R(2) = 0.97) than a linear function (R(2) = 0.63), confirming a proportional recent decline in LD flap procedures. Conversely, autologous (non-LD) flap reconstructions have increased (1996 = 0.44%; 2012 = 2.76%), whereas implant-only reconstructions have declined (1996 = 95.42%; 2012 = 84.92%). Locally, 70 implant-assisted LD procedures were performed in 2003 -2004, but only 2 were performed in 2012 to 2013.Implants are the most common IBR technique; autologous free flap procedures have increased, and pedicled LD flap procedures are in decline

Factors associated with hospital emergency readmission and mortality rates in patients with heart failure or chronic obstructive pulmonary disease: a national observational study

Background: Heart failure (HF) and chronic obstructive pulmonary disease (COPD) lead to unplanned hospital activity, but our understanding of what drives this is incomplete. Objectives: To model patient, primary care and hospital factors associated with readmission and mortality for patients with HF and COPD, to assess the statistical performance of post-discharge emergency department (ED) attendance compared with readmission metrics and to compare all the results for the two conditions. Design: Observational study. Setting: English NHS. Participants: All patients admitted to acute non-specialist hospitals as an emergency for HF or COPD. Interventions: None. Main outcome measures: One-year mortality and 30-day emergency readmission following the patient’s first unplanned admission (‘index admission’) for HF or COPD. Data sources: Patient-level data from Hospital Episodes Statistics were combined with publicly available practice- and hospital-level data on performance, patient and staff experience and rehabilitation programme website information. Results: One-year mortality rates were 39.6% for HF and 24.1% for COPD and 30-day readmission rates were 19.8% for HF and 16.5% for COPD. Most patients were elderly with multiple comorbidities. Patient factors predicting mortality included older age, male sex, white ethnicity, prior missed outpatient appointments, (long) index length of hospital stay (LOS) and several comorbidities. Older age, missed appointments, (short) LOS and comorbidities also predicted readmission. Of the practice and hospital factors we considered, only more doctors per 10 beds [odds ratio (OR) 0.95 per doctor; p < 0.001] was significant for both cohorts for mortality, with staff recommending to friends and family (OR 0.80 per unit increase; p < 0.001) and number of general practitioners (GPs) per 1000 patients (OR 0.89 per extra GP; p = 0.004) important for COPD. For readmission, only hospital size [OR per 100 beds = 2.16, 95% confidence interval (CI) 1.34 to 3.48 for HF, and 2.27, 95% CI 1.40 to 3.66 for COPD] and doctors per 10 beds (OR 0.98; p < 0.001) were significantly associated. Some factors, such as comorbidities, varied in importance depending on the readmission diagnosis. ED visits were common after the index discharge, with 75% resulting in admission. Many predictors of admission at this visit were as for readmission minus comorbidities and plus attendance outside the day shift and numbers of admissions that hour. Hospital-level rates for ED attendance varied much more than those for readmission, but the omega statistics favoured them as a performance indicator. Limitations: Data lacked direct information on disease severity and ED attendance reasons; NHS surveys were not specific to HF or COPD patients; and some data sets were aggregated. Conclusions: Following an index admission for HF or COPD, older age, prior missed outpatient appointments, LOS and many comorbidities predict both mortality and readmission. Of the aggregated practice and hospital information, only doctors per bed and numbers of hospital beds were strongly associated with either outcome (both negatively). The 30-day ED visits and diagnosis-specific readmission rates seem to be useful performance indicators. Future work: Hospital variations in ED visits could be investigated using existing data despite coding limitations. Primary care management could be explored using individual-level linked databases. Funding: The National Institute for Health Research Health Services and Delivery Research programme

Regional variation in trajectories of long-term readmission rates among patients in England with heart failure

Background We aimed to compare the characteristics and types of heart failure (HF) patients termed “high-impact users”, with high long-term readmission rates, in different regions in England. This will allow clinical factors to be identified in areas with potentially poor quality of care. Methods Patients with a primary diagnosis of heart failure (HF) in the period 2008–2009 were identified using nationally representative primary care data linked to national hospital data and followed up for 5 years. Group-based trajectory models and sequence analysis were applied to their readmissions. Results In each of the 8 NHS England regions, multiple discrete groups were identified. All the regions had high-impact users. The group with an initially high readmission rate followed by a rapid decline in the rate ranged from 2.5 to 11.3% across the regions. The group with constantly high readmission rate compared with other groups ranged from 1.9 to 12.1%. Covariates that were commonly found to have an association with high-impact users among most of the regions were chronic respiratory disease, chronic renal disease, stroke, anaemia, mood disorder, and cardiac arrhythmia. Respiratory tract infection, urinary infection, cardiopulmonary signs and symptoms and exacerbation of heart failure were common causes in the sequences of readmissions among high-impact users in all regions. Conclusion There is regional variation in England in readmission and mortality rates and in the proportions of HF patients who are high-impact users

Tracking performance and its underlying characteristics in talented swimmers:a longitudinal study during the junior-to-senior transition

The present study strived to gain a more profound understanding of the distinctions in development between swimmers who are considered to be on track to the senior elite level compared to those who are not. Longitudinal data of 29 talented sprint and middle-distance swimmers (12 males; 17 females) on season best performances (season best times) and underlying performance characteristics (anthropometrics, starts, turns, maximal swimming velocity, stroke index [SI, an indirect measure of swimming efficiency] and lower body power) were collected over four swimming seasons (median of n = 3 seasons per swimmer). Based on their season best performance at early senior age (males aged 18–19; females aged 17–18), some swimmers were considered to be on track to reach the elite level (referred to as high-performing seniors; 6 males and 10 females), whereas others were not (referred to as lower-performing seniors; 6 males and 7 females). Retrospectively studying these swimmers (males and females separately), we found that all high-performing seniors were already on track to the elite level at late junior age (males aged 17; females aged 16), evidenced with faster season best performances throughout their transition compared to their lower-performing peers (p &lt; 0.05). Independent sample t-tests revealed that high-performing seniors significantly outscored their lower-performing peers on maximal swimming velocity (males and females), starts and turns (males), SI (females) and lower body power (females) at late junior age (p &lt; 0.05). Additionally, multilevel models showed faster rates of development for high-performing seniors on turns and maximal swimming velocity (males), and SI (females) compared to lower-performing peers during the junior-to-senior transition (p &lt; 0.05). Particularly, the higher initial levels of swim performance and underlying characteristics at late junior age as well as the ability to keep progressing on season best performances (males and females), turns and maximal swimming velocity (males), and SI (females) during the junior-to-senior transition, may be crucial factors in the attainment of swimming expertise.</p

Functional properties of brewer’s spent grain protein isolate. The missing piece in the plant protein portfolio

Plant protein sources, as a part of developing sustainable food systems, are currently of interest globally. Brewer’s spent grain (BSG) is the most plentiful by-product of the brewing industry, representing ~85% of the total side streams produced. Although nutritionally dense, there are very few methods of upcycling these materials. High in protein, BSG can serve as an ideal raw material for protein isolate production. This study details the nutritional and functional characteristics of BSG protein isolate, EverPro, and compares these with the technological performance of the current gold standard plant protein isolates, pea and soy. The compositional characteristics are determined, including amino acid analysis, protein solubility, and protein profile among others. Related physical properties are determined, including foaming characteristics, emulsifying properties, zeta potential, surface hydrophobicity, and rheological properties. Regarding nutrition, EverPro meets or exceeds the requirement of each essential amino acid per g protein, with the exception of lysine, while pea and soy are deficient in methionine and cysteine. EverPro has a similar protein content to the pea and soy isolates, but far exceeds them in terms of protein solubility, with a protein solubility of ~100% compared to 22% and 52% for pea and soy isolates, respectively. This increased solubility, in turn, affects other functional properties; EverPro displays the highest foaming capacity and exhibits low sedimentation activity, while also possessing minimal gelation properties and low emulsion stabilising activity when compared to pea and soy isolates. This study outlines the functional and nutritional properties of EverPro, a brewer’s spent grain protein, in comparison to commercial plant protein isolates, indicating the potential for the inclusion of new, sustainable plant-based protein sources in human nutrition, in particular dairy alternative applications

From waste to taste. Application of fermented spent rootlet ingredients in a bread system

The process of upcycling and incorporating food by-products into food systems as functional ingredients has become a central focus of research. Barley rootlets (BR) are a by-product of the malting and brewing industries that can be valorised using lactic acid bacteria fermentation. This research investigates the effects of the inclusion of unfermented (BR-UnF), heat-sterilised (BR-Ster), and five fermented BR ingredients (using Weissella cibaria MG1 (BR-MG1), Leuconostoc citreum TR116 (BR-TR116), Lactiplantibacillus plantarum FST1.7 (BR-FST1.7), Lactobacillus amylovorus FST2.11 (BR-FST2.11), and Limosilactobacillus reuteri R29 (BR-R29) in bread. The antifungal compounds in BR ingredients and the impact of BR on dough rheology, gluten development, and dough mixing properties were analysed. Additionally, their effects on the techno-functional characteristics, in vitro starch digestibility, and sensory quality of bread were determined. BR-UnF showed dough viscoelastic properties and bread quality comparable to the baker's flour (BF). BR-MG1 inclusion ameliorated bread specific volume and reduced crumb hardness. Breads containing BR-TR116 had comparable bread quality to BF, while the inclusion of BR-R29 substantially slowed microbial spoilage. Formulations containing BR-FST2.11 and BR-FST1.7 significantly reduced the amounts of sugar released from breads during a simulated digestion and resulted in a sourdough-like flavour profile. This study highlights how BR fermentation can be tailored to achieve desired bread characteristics

Multigenerational performance development of male and female top-elite swimmers-A global study of the 100 m freestyle event

Background The present study investigated longitudinally the performance development of a multigenerational sample of competitive swimmers. The aim of the study was to provide unique insight into the junior toward senior performance development of those few who reached top-elite level. Season Best Times (SBT) of 100 m freestyle performance of international swimmers, (1.305 males, aged 12-26 and 1.841 females, aged 12-24) competing in at least five seasons between 1993 and 2018, were corrected for the prevailing world record (WR). Swim performance was defined as a relative measure: relative Season Best Time=(SBT/WR) x 100. Based on rSBT, four performance groups were defined: top-elite, elite, sub-elite, and high-competitive. Results Univariate analyses of variance showed that male top-elite swimmers outperformed high-competitive swimmers from the age of 12, sub-elite swimmers from the age of 14 and elite swimmers from the age of 18 while female top-elite swimmers outperformed high-competitive and sub-elite swimmers from the age of 12 and elite swimmers from the age of 14 (P <.05). Frequency analysis showed that male top-elite swimmers for the first time achieved top-elite level between the 17 and 24 years old (mean age of 21) while female top-elite swimmers started to perform at top-elite level between the 14 and 24 years old (mean age of 18). Conclusion Male and female top-elite swimmers are characterized by a high-performance level from 12 years on and progressively outperform swimmers from similar age. However, this goes together with a large variety in the individual pathways toward top-elite level within and between sexes