Six-month outcomes after individualized nutritional support during the hospital stay in medical patients at nutritional risk: Secondary analysis of a prospective randomized trial.

BACKGROUND Among medical inpatients at risk of malnutrition, the use of individualized nutritional support during the hospital stay was found to reduce complications and improve mortality at short-term. We evaluated clinical outcomes at 6-months follow-up. METHODS We randomly assigned 2028 patients to receive protocol-guided individualized nutritional support to reach protein and energy goals (intervention group) or hospital food as usual (control group) during the hospital stay. The intervention was discontinued at hospital discharge and further nutritional support was based on the discretion of the treating team. We had complete follow-up information of 1995 patients (98%), which were included in the final analysis. The primary endpoint was all-cause mortality at 6-months. Prespecified secondary end points included non-elective hospital readmissions, functional outcome and quality of life. RESULTS At 6-month, 231 of 994 (23.2%) intervention group patients had died compared to 246 of 999 (24.6%) control group patients, resulting in a hazard ratio for death of 0.90 (95%CI 0.76 to 1.08, p = 0.277). Compared to control patients, intervention group patients had similar rates of hospital readmission (27.3% vs. 27.6%, HR 1.00 (95%CI 0.84 to 1.18), p = 0.974), falls (11.2% vs. 10.9%, HR 0.96 (95%CI 0.72 to 1.27), p = 0.773) and similar quality of life and activities of daily living scores. INTERPRETATION While individualized nutritional support during the hospital stay significantly reduced short-term mortality, there was no legacy effect on longer term outcomes. Future trials should investigate whether continuation of nutritional support after hospital discharge reduces the high malnutrition-associated mortality rates in this vulnerable patient population. TRIAL REGISTRATION ClinicalTrials.gov number, NCT02517476

Etiology, 3-Month Functional Outcome and Recurrent Events in Non-Traumatic Intracerebral Hemorrhage.

BACKGROUND AND PURPOSE Knowledge about different etiologies of non-traumatic intracerebral hemorrhage (ICH) and their outcomes is scarce. METHODS We assessed prevalence of pre-specified ICH etiologies and their association with outcomes in consecutive ICH patients enrolled in the prospective Swiss Stroke Registry (2014 to 2019). RESULTS We included 2,650 patients (mean±standard deviation age 72±14 years, 46.5% female, median National Institutes of Health Stroke Scale 8 [interquartile range, 3 to 15]). Etiology was as follows: hypertension, 1,238 (46.7%); unknown, 566 (21.4%); antithrombotic therapy, 227 (8.6%); cerebral amyloid angiopathy (CAA), 217 (8.2%); macrovascular cause, 128 (4.8%); other determined etiology, 274 patients (10.3%). At 3 months, 880 patients (33.2%) were functionally independent and 664 had died (25.1%). ICH due to hypertension had a higher odds of functional independence (adjusted odds ratio [aOR], 1.33; 95% confidence interval [CI], 1.00 to 1.77; P=0.05) and lower mortality (aOR, 0.64; 95% CI, 0.47 to 0.86; P=0.003). ICH due to antithrombotic therapy had higher mortality (aOR, 1.62; 95% CI, 1.01 to 2.61; P=0.045). Within 3 months, 4.2% of patients had cerebrovascular events. The rate of ischemic stroke was higher than that of recurrent ICH in all etiologies but CAA and unknown etiology. CAA had high odds of recurrent ICH (aOR, 3.38; 95% CI, 1.48 to 7.69; P=0.004) while the odds was lower in ICH due to hypertension (aOR, 0.42; 95% CI, 0.19 to 0.93; P=0.031). CONCLUSIONS Although hypertension is the leading etiology of ICH, other etiologies are frequent. One-third of ICH patients are functionally independent at 3 months. Except for patients with presumed CAA, the risk of ischemic stroke within 3 months of ICH was higher than the risk of recurrent hemorrhage

Waiting... with Rachel and Peter: Podcast funded by Arts Council England/Wellcome Trust

Fuel, Roundhouse and King’s Cultural Institute present Waiting… with Rachel and Peter By Stefan Kaegi in collaboration with Anna Jordanous and Niki Neecke. Voices by Acapela Group. Waiting… with Rachel and Peter is the fourth in our new series of podcasts called While You Wait, each of which is a different meditation on the idea of waiting and created by artists in collaboration with academics from King's College London. Waiting… with Rachel and Peter has been made by Berlin based artist Stefan Kaegi in collaboration with Anna Jordanous, Research Associate, Centre for e-Research and sound designer Niki Neecke. While You Wait is funded by Arts Council England and a Wellcome Trust Arts Award. An accompanying video interview featuring Stefan Kaegi and Anna Jordanous is available at https://www.youtube.com/watch?v=GcG43H_jMN

Long-term assessment of nanoplastic particle and microplastic fiber flux through a pilot wastewater treatment plant using metal-doped plastics

In recent years, several studies have investigated the flux of particulate plastic through municipal waste water treatment plants (WWTP). Challenges related to time consuming analytical methods have limited the number of sampling points and detection limits have hampered quantification of nanoplastic and microplastic fiber fluxes through WWTPs. By synthesizing nanoplastic particles and microplastic fibers labeled with a rare metal (Pd and In, respectively) which can be measured as a proxy for the plastic itself, we have circumvented major analytical pitfalls associated with (micro)plastic measurements. In this study, we spiked the labeled materials to a pilot WWTP mimicking the activated sludge process (nitrification, de-nitrification and secondary clarification). Using a mass flow model for WWTP sludge, we assessed the behavior of particulate plastic in relation to the removal of organic matter. Triplicate samples were collected from the mixed liquor and from the effluent at least twice weekly over the entire experimental run time of 40 d. Our findings show that in discrete grab samples during steady state conditions, at least 98% of particulate plastics were associated with the biosolids. A positive correlation between total suspended solids (TSS) and plastic concentrations was observed in the sludge as well as in the effluent. Because of the strong association between particulate plastic and TSS, TSS removal is likely a good indicator of plastic removal in a full scale WWTP. Therefore, additional process steps in a full-scale WWTP which further reduce the TSS load will likely retain nanoplastic particles and microplastic fibers effectively and consequently increase the removal rates.ISSN:0043-1354ISSN:1879-244

"A change-over between direct visit and mediated" : an e-mail interview with Rimini Protocol on Situation Rooms

Rimini Protokoll's Situation Rooms was first 'played out' on 23 August 2013 at the Turbinenhalle in Bochum. This "Multiplayer Video-Piece" is a remarkable experiment in participatory theatre, which combines elements of installation, "expert"-theatre, parcours and re-enactment. The following text provides a brief description of Situation Rooms, followed by an e-mail interview with Helgard Haug, Stefan Kaegi and Daniel Wetzel. This interview addresses questions and topics such as: the hybrid genre of Situation Rooms, its relation to earlier works, specific compositional decisions (about duration, the use of iPads, absent "experts"), and the piece's approach to interaction with the audience (including potential cognitive overload and denial of space for individual assessments, immersion, incompleteness as a principle), and aspects of audience feedback. The interview also considers the role of empathy, audiences' emotional involvement, the work's (apparent) proximity to practices of traditional theatre, and participation as an aspect of theatre and politics.21 page(s

Panel discussion : 100% Melbourne : contemporary documentary performance that puts 'real Melbournians' on the stage

On 5 May 2012 at the Goethe-Institut in the Australian city of Melbourne, Haug and Kaegi participated in a panel discussion that focused in particular on the 100% Melbourne production. In the transcript extract presented in this volume, which covers the first c. 55 minutes of the discussion, topics addressed include: choice of performance space, set design, casting, research and rehearsal processes, working with statistics and the notion of truthfulness, adapting each iteration of the 100% format to local cultures, collaboration and composition practices, and approaches to structure and narration.16 page(s

Formation and transformation of Fe(III)- and Ca-precipitates in aqueous solutions and effects on phosphate retention over time

Exfiltration of anoxic phosphate-rich groundwater into surface water leads to the oxidation of dissolved Fe(II) and the formation of Fe(III)-precipitates that can retain phosphate (PO₄) and thereby attenuate eutrophication. Fresh Fe(III)-precipitates transform into more stable phases over time, and retained PO₄ may be released again. In parallel, CO₂ outgassing can promote the formation of Ca-phosphates or -carbonates that also sequester PO₄. In laboratory experiments, we studied the effects of Mg, Ca, silicate (SiO₄) and PO₄ on these processes. Fresh Fe(III)-precipitates were formed in bicarbonate-buffered aqueous solutions at pH ∼ 7.0 via the oxidation of 0.5 mM Fe(II) in the presence of 0.15 or 0.025 mM PO₄, at Mg or Ca concentrations of 0, 0.4, 1.2 or 4 mM and in the absence or presence of 0.5 mM SiO₄. After CO₂ outgassing, the suspensions were allowed to age for 100 d at pH ∼ 8. Changes in the composition and structure of Fe(III)- and Ca-precipitates over time were probed with spectroscopic and microscopic techniques and were linked to variations in the retention of PO₄. The oxidation of Fe(II) led to effective PO₄ removal via the formation of Fe(III)-precipitates that consisted of amorphous (Ca-)Fe(III)-phosphate ((Ca)FeP), ferrihydrite (Fh) and, in SiO₄-free treatments, lepidocrocite (Lp). During aging, FeP and Fh that had formed in the absence of Mg, Ca and SiO₄ rapidly and nearly completely transformed into Lp. Via effects on molecular- and nanoscale precipitate structure, Mg slowed down FeP transformation into Fh, stabilized Fh, and decreased the crystallinity of Lp (in SiO₄-free suspensions), Ca stabilized CaFeP against transformation into Fh, and SiO₄ stabilized Fh and (Ca)FeP. Core/shell CaFeP/Fh particles formed in electrolytes that contained Ca and SiO₄ hardly transformed within 100 d. Calcite only formed at low dissolved PO₄ concentrations and, by incorporation of PO₄, contributed to PO₄ retention. Higher levels of dissolved PO₄ inhibited calcite formation but could induce Ca-phosphate precipitation. Differences in precipitate formation and transformation pathways and kinetics were reflected in the extents of PO₄ release over the 100-d aging period, ranging from rapid release of 77% of the total PO₄ in the treatment without Mg, Ca and SiO₄ at 0.15 mM total PO₄ to slow release of only 0.1% of the total PO at initial concentrations of 4 mM Ca, 0.5 mM SiO₄, and 0.025 mM PO₄. In summary, this study reveals the conditions and the extents and timescales over which Fe(III)- and Ca-precipitates form and transform and how these processes affect PO₄ immobilization in near-neutral natural waters. The detailed new insights into the coupling between Fe(III)- and Ca-precipitate formation and into the interdependent effects of Mg, Ca, SiO₄ and PO₄ are not only relevant with respect to PO₄ but also with respect to the cycling of trace elements in natural and engineered systems.ISSN:0016-7037ISSN:1872-953