Chemosensory abilities in consumers of a western-style diet

People vary in their habitual diet and also in their chemosensory abilities. In this study we examined whether consumption of a Western-style diet, rich in saturated fat and added sugar, is associated with either poorer or different patterns of chemosensory perception, relative to people who consume a healthier diet. Participants were selected based on a food frequency questionnaire, which established whether they were likely to consume a diet either higher or lower in saturated fat and added sugar. Eighty-seven participants were tested for olfactory ability (threshold, discrimination, identification), gustatory ability (PROP sensitivity, taste intensity, quality and hedonics), and flavour processing (using dairy fat-sugar-odour mixtures). A Western-style diet was associated with poorer odour identification ability, greater PROP sensitivity, poorer fat discrimination, different patterns of sweetness taste enhancement, and hedonic differences in taste and flavour perception. No differences were evident for odour discrimination or threshold, in perception of taste intensity/quality (excluding PROP) or the ability of fats to affect flavour perception. The significant relationships were of small to moderate effect size, and would be expected to work against consuming a healthier diet. The discussion focuses on whether these diet-related differences precede adoption of a Western-style diet and/or are a consequence of it

NOVEL GAS CLEANING/CONDITIONING FOR INTEGRATED GASIFICATION COMBINED CYCLE

Development efforts have been underway for decades to replace dry-gas cleaning technology with humid-gas cleaning technology that would maintain the water vapor content in the raw gas by conducting cleaning at sufficiently high temperature to avoid water vapor condensation and would thus significantly simplify the plant and improve its thermal efficiency. Siemens Power Generation, Inc. conducted a program with the Gas Technology Institute (GTI) to develop a Novel Gas Cleaning process that uses a new type of gas-sorbent contactor, the ''filter-reactor''. The Filter-Reactor Novel Gas Cleaning process described and evaluated here is in its early stages of development and this evaluation is classified as conceptual. The commercial evaluations have been coupled with integrated Process Development Unit testing performed at a GTI coal gasifier test facility to demonstrate, at sub-scale the process performance capabilities. The commercial evaluations and Process Development Unit test results are presented in Volumes 1 and 2 of this report, respectively. Two gas cleaning applications with significantly differing gas cleaning requirements were considered in the evaluation: IGCC power generation, and Methanol Synthesis with electric power co-production. For the IGCC power generation application, two sets of gas cleaning requirements were applied, one representing the most stringent ''current'' gas cleaning requirements, and a second set representing possible, very stringent ''future'' gas cleaning requirements. Current gas cleaning requirements were used for Methanol Synthesis in the evaluation because these cleaning requirements represent the most stringent of cleaning requirements and the most challenging for the Filter-Reactor Novel Gas Cleaning process. The scope of the evaluation for each application was: (1) Select the configuration for the Filter-Reactor Novel Gas Cleaning Process, the arrangement of the individual gas cleaning stages, and the probable operating conditions of the gas cleaning stages to conceptually satisfy the gas cleaning requirements; (2) Estimate process material & energy balances for the major plant sections and for each gas cleaning stage; (3) Conceptually size and specify the major gas cleaning process equipment; (4) Determine the resulting overall performance of the application; and (5) Estimate the investment cost and operating cost for each application. Analogous evaluation steps were applied for each application using conventional gas cleaning technology, and comparison was made to extract the potential benefits, issues, and development needs of the Filter-Reactor Novel Gas Cleaning technology. The gas cleaning process and related gas conditioning steps were also required to meet specifications that address plant environmental emissions, the protection of the gas turbine and other Power Island components, and the protection of the methanol synthesis reactor. Detailed material & energy balances for the gas cleaning applications, coupled with preliminary thermodynamic modeling and laboratory testing of candidate sorbents, identified the probable sorbent types that should be used, their needed operating conditions in each stage, and their required levels of performance. The study showed that Filter-Reactor Novel Gas Cleaning technology can be configured to address and conceptually meet all of the gas cleaning requirements for IGCC, and that it can potentially overcome several of the conventional IGCC power plant availability issues, resulting in improved power plant thermal efficiency and cost. For IGCC application, Filter-Reactor Novel Gas Cleaning yields 6% greater generating capacity and 2.3 percentage-points greater efficiency under the Current Standards case, and more than 9% generating capacity increase and 3.6 percentage-points higher efficiency in the Future Standards case. While the conceptual equipment costs are estimated to be only slightly lower for the Filter-Reactor Novel Gas Cleaning processes than for the conventional processes, the improved power plant capacity results in the potential for significant reductions in the plant cost-of-electricity, about 4.5% for the Current Standards case, and more than 7% for the Future Standards case. For Methanol Synthesis, the Novel Gas Cleaning process scheme again shows the potential for significant advantages over the conventional gas cleaning schemes. The plant generating capacity is increased more than 7% and there is a 2.3%-point gain in plant thermal efficiency. The Total Capital Requirement is reduced by about 13% and the cost-of-electricity is reduced by almost 9%. For both IGCC Methanol Synthesis cases, there are opportunities to combine some of the filter-reactor polishing stages to simplify the process further to reduce its cost. This evaluation has devised plausible humid-gas cleaning schemes for the Filter-Reactor Novel Gas Cleaning process that might be applied in IGCC and Methanol Synthesis applications

More than sense of place? Exploring the emotional dimension of rural tourism experiences

It is widely suggested that participation in rural tourism is underpinned by a sense of rural place or “rurality”. However, although nature and the countryside have long been recognised as a source of spiritual or emotional fulfilment, few have explored the extent to which tourism, itself often claimed to be a sacred experience, offers an emotional/spiritual dimension in the rural context. This paper addresses that literature gap. Using in-depth interviews with rural tourists in the English Lake District, it explores the extent to which, within respondents’ individual understanding of spirituality, a relationship exists between sense of place and deeper, emotional experiences and, especially, whether participation in rural tourism may induce spiritual or emotional responses. The research revealed that all respondents felt a strong attachment to the Lake District; similarly, and irrespective of their openness to spirituality, engaging in rural tourism activities resulted in highly emotive experiences for all respondents, the description/interpretation of such experiences being determined by individual “beliefs”. However, sense of place was not a prerequisite to emotional or spiritual experiences. Being in and engaging with the landscape � effectively becoming part of it � especially through physical activity is fundamental to emotional responses

Atrial Fibrillation and In-Hospital Mortality in Covid-19 patients

BACKGROUND: There are conflicting data on whether new-onset atrial fibrillation (AF) is independently associated with poor outcomes in COVID-19 patients. This study represents the largest dataset curated by manual chart review comparing clinical outcomes between patients with sinus rhythm, pre-existing AF, and new-onset AF. OBJECTIVE: The primary aim of this study was to assess patient outcomes in COVID-19 patients with sinus rhythm, pre-existing AF, and new-onset AF. The secondary aim was to evaluate predictors of new-onset AF in patients with COVID-19 infection. METHODS: This was a single-center retrospective study of patients with a confirmed diagnosis of COVID-19 admitted between March and September 2020. Patient demographic data, medical history, and clinical outcome data were manually collected. Adjusted comparisons were performed following propensity score matching between those with pre-existing or new-onset AF and those without AF. RESULTS: The study population comprised of 1241 patients. A total of 94 (7.6%) patients had pre-existing AF and 42 (3.4%) patients developed new-onset AF. New-onset AF was associated with increased in-hospital mortality before (odds ratio [OR] 3.58, 95% confidence interval [CI] 1.78-7.06, P < .005) and after (OR 2.80, 95% CI 1.01-7.77, P < .005) propensity score matching compared with the no-AF group. However, pre-existing AF was not independently associated with in-hospital mortality compared with patients with no AF (postmatching OR: 1.13, 95% CI 0.57-2.21, P = .732). CONCLUSION: New-onset AF, but not pre-existing AF, was independently associated with elevated mortality in patients hospitalised with COVID-19. This observation highlights the need for careful monitoring of COVID-19 patients with new-onset AF. Further research is needed to explain the mechanistic relationship between new-onset AF and clinical outcomes in COVID-19 patients

Framework for evaluating the health impact of the scale-up of malaria control interventions on all-cause child mortality in Sub-Saharan Africa

Concerted efforts from national and international partners have scaled up malaria control interventions, including insecticide-treated nets, indoor residual spraying, diagnostics, prompt and effective treatment of malaria cases, and intermittent preventive treatment during pregnancy in sub-Saharan Africa (SSA). This scale-up warrants an assessment of its health impact to guide future efforts and investments; however, measuring malaria-specific mortality and the overall impact of malaria control interventions remains challenging. In 2007, Roll Back Malaria's Monitoring and Evaluation Reference Group proposed a theoretical framework for evaluating the impact of full-coverage malaria control interventions on morbidity and mortality in high-burden SSA countries. Recently, several evaluations have contributed new ideas and lessons to strengthen this plausibility design. This paper harnesses that new evaluation experience to expand the framework, with additional features, such as stratification, to examine subgroups most likely to experience improvement if control programs are working; the use of a national platform framework; and analysis of complete birth histories from national household surveys. The refined framework has shown that, despite persisting data challenges, combining multiple sources of data, considering potential contributions from both fundamental and proximate contextual factors, and conducting subnational analyses allows identification of the plausible contributions of malaria control interventions on malaria morbidity and mortality

The science of clinical practice: disease diagnosis or patient prognosis? Evidence about "what is likely to happen" should shape clinical practice.

BACKGROUND: Diagnosis is the traditional basis for decision-making in clinical practice. Evidence is often lacking about future benefits and harms of these decisions for patients diagnosed with and without disease. We propose that a model of clinical practice focused on patient prognosis and predicting the likelihood of future outcomes may be more useful. DISCUSSION: Disease diagnosis can provide crucial information for clinical decisions that influence outcome in serious acute illness. However, the central role of diagnosis in clinical practice is challenged by evidence that it does not always benefit patients and that factors other than disease are important in determining patient outcome. The concept of disease as a dichotomous 'yes' or 'no' is challenged by the frequent use of diagnostic indicators with continuous distributions, such as blood sugar, which are better understood as contributing information about the probability of a patient's future outcome. Moreover, many illnesses, such as chronic fatigue, cannot usefully be labelled from a disease-diagnosis perspective. In such cases, a prognostic model provides an alternative framework for clinical practice that extends beyond disease and diagnosis and incorporates a wide range of information to predict future patient outcomes and to guide decisions to improve them. Such information embraces non-disease factors and genetic and other biomarkers which influence outcome. SUMMARY: Patient prognosis can provide the framework for modern clinical practice to integrate information from the expanding biological, social, and clinical database for more effective and efficient care

2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischem

In the article by Levine et al, “2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery,” which published online March 29, 2016, and appeared in the September 6, 2016, issue of the journal ( Circulation. 2016;134:e123–e155. DOI: 10.1161/CIR.0000000000000404.), several corrections were needed. 1. On pages e124 and e134, corrections have been made to the section 5 title: 2. On pages e124 and e135, corrections have been made to the section 6 title: 3. On page

Heritage in trust: sustainable stewardship in transition?

Founded in 1895 as a society for the preservation of natural beauty and historic interest, the National Trust starts its second century as Britain's largest private landowner. Its portfolio of property - natural and built, rural and urban, ancient and modern - is unique in its variety and quality. With its membership of over 2 million the Trust is also the world's largest voluntary conservation organisation. Frequently identified with 'establishment' values (though on occasion seen as subversive of them) the Trust has as often been a focus of critique as of celebration. This paper examines the Trust's changing relation to contested values of heritage as manifest in its acquisitions and management policies, in its engagement with environmental and social issues and an emerging politicisation which transcends a narrow, purely property- based interpretation of its statutory purpose. Recent acquisitions challenge conventional perceptions of 'natural beauty' and 'historic interest'. Organisational greening has precipitated a review of the implications of stewardship 'in perpetuity'. Recognition of the needs of local communities and awareness of equal opportunities issues have prompted a reinterpretation of its founders' concerns with access and enjoyment 'for the nation'. The outcome is an inchoate shift in the emphasis in heritage management from the preservation of the status quo, to the management of change, not merely within the context of its own heritage portfolio but also of the environmental and social context within which it is managed and presented