Improving outcomes for older people in the emergency department : a review of reviews

Background: There has been a recognised trend of increasing use of emergency and urgent care and emergency departments (EDs) by older people, which is marked by a substantial evidence base reporting interventions for this population and guidance from key organisations. Despite this, outcomes for this population remain suboptimal. A plethora of reviews in this area provides challenges for clinicians and commissioners in determining which interventions and models of care best meet people’s needs. The aim of this review was to identify effective ED interventions which have been reported for older people, and to provide a clear summary of the myriad reviews and numerous intervention types in this area. Methods: A review of reviews, reporting interventions for older people, either initiated or wholly delivered within the ED. Results: A total of 15 review articles describing 83 primary studies met our content and reporting standards criteria. The majority (n=13) were systematic reviews (four using meta-analysis.) Across the reviews, 26 different outcomes were reported with inconsistency. Follow-up duration varied within and across the reviews. Based on how authors had reported results, evidence clusters were developed: (1) staff-focused reviews, (2) discharge intervention reviews, (3) population-focused reviews and (4) intervention component reviews. Conclusions: The evidence base describing interventions is weak due to inconsistent reporting, differing emphasis placed on the key characteristics of primary studies (staff, location and outcome) by review authors and varying quality of reviews. No individual interventions have been found to be more promising, but interventions initiated in the ED and continued into other settings have tended to result in more favourable patient and health service outcomes. Despite many interventions reported within the reviews being holistic and patient focused, outcomes measured were largely service focused. PROSPERO registration number: PROSPERO CRD42018111461

The effect of feeding different sources and levels of selenium on growth performance and antioxidant status of broilers raised at two different temperatures

1.This study examined the effects of different dietary sources and levels of selenium (Se) on growth performance, hepatic and breast meat Se content, glutathione peroxidase (GSH-Px) activity and total antioxidant status (TAS) in blood, when fed to broilers from 14 to 35 d of age and reared at two different temperatures (20°C and 35 °C). 2. Five hundred and sixty male Ross 308 broilers were reared in a single floor pen and fed the same proprietary starter diet from 0 to 14 d age (229.9 g/kg CP and 12.67 MJ/kg ME, without Se supplementation). 3. The experiment started at 14 d age, and the birds randomly assigned to 112 raised-floor pens (0.36m2 area, 5 birds/pen). Each of the seven experimental diets were offered to birds in 16 pens within four rooms. Two rooms were at 20°C and two rooms were maintained at 35°C. The experimental diets were fed from 14 to 35 d age and contained 214.9 g/kg CP and 13.11 MJ/kg ME. The experimental diets were as follows; control diet containing background Se only (0.189 mg/kg; C); low level sodium selenite (0.376 mg/kg; LSS): high level sodium selenite (0.558 mg/kg; HSS); low level commercial B Traxim® Se (0.244 mg/kg) (LBT); high level B Traxim® Se (0.448 mg/kg; HBT); low level selenised yeast (0.290 mg/kg; LSY); high level selenised yeast (0.487 mg/kg; HSY). 4. Birds consumed more when raised at 20°C compared to birds reared at 35°C (P≤0.05). Birds fed lower Se level reared at 35°C had higher weight gain versus those fed higher Se level (P<0.05). Birds fed SY had the lowest feed intake, weight gain and FCE (P<0.05). The greatest GSH-Px activity was observed in birds fed SS diets (P<0.001). There were interactions between diet x level for TAS, which were highest in birds fed LBT compared to birds fed HBT (P<0.05). Breast Se content was higher in birds fed HSY compared to LSY (P<0.001). The highest hepatic Se was seen in birds fed SY and lowest in C (P<0.001). 5. Birds fed BT diets showed similar levels of Se to those birds fed inorganic Se, and similar levels of GSH-Px to birds fed SY. Further comparative work with broilers fed BT and other Se supplemented diets may elucidate the findings from this report

Effect of age on the relationship between metabolizable energy and digestible energy for broiler chickens

A total of 960 male Ross 308 chicks (day-old) were used to investigate the effect of age on the relationship between metabolizable energy (ME) and digestible energy (DE) for broiler chickens. Bird growth variables, nitrogen retention (NR), nitrogen digestibility (ND), as well as the relative weight of liver, pancreas, and the gastrointestinal tract were determined. Practical diets that compared 2 cereals (corn and wheat) and exogenous xylanase (0 or 16,000 BXU/kg) were evaluated at 5 ages (7, 14, 21, 28, and 35 D) in a 2 × 2 × 5 factorial arrangement of treatments with 8 replicates per treatment and started with 30 birds per replicate. A randomized block ANOVA analysis of repeated measures was performed, and a 2 × 2 × 5 factorial structure was used to investigate the 2 dietary treatment factors (cereal type and the presence of xylanase) within the 5 bird ages (7, 14, 21, 28, and 35 D), and their interactions. Apparent metabolizable energy (AME) increased linearly from 7 until 28 D of age, but (P 0.05) from 14 to 35 D of age. The AME: DE ratio was lowest (P 0.05) differences thereafter. Cereal type and xylanase supplementation did not (P > 0.05) change the ME: DE ratio. The results indicate that determining ME before 14 D of age may give absolute values that are lower than would be obtained with older birds. ME values that are determined on older broiler chickens may overestimate the energy availability of practical feeds used in broiler starter feeds

Feeding dihydroquercetin to broiler chickens

1. A total of 80 male Ross 308 broilers were used in a study to investigate the effect of dietary dihydroquercetin (DHQ) on growth performance variables, gastrointestinal tract (GIT) and immune organ development, glutathione peroxidase (GPx) and haemoglobin in blood, hepatic vitamin E content, dietary N-corrected metabolisable energy (AMEn), and nutrient retention coefficients when fed to broiler chickens from 7 to 35 days of age. 2. Two treatments were used in this study: control (C) and C + 0.5 g/kg extract of Siberian Larch (Larix sibirica) per kg feed, containing 85 % DHQ. The diets were fed over two feeding phases, a grower phase from 7 to 28 d of age, and a finisher phase from 28 to 35 d of age. The birds were reared under the breeder’s recommended conditions. 3. In general, there were no effects of DHQ on growth performance of broiler chickens. However, the results of this experiment showed that there can be changes in redness colour of the breast meat when DQH is fed. No negative effects of feeding DHQ at 0.5 g/kg diet were observed in this study. 4. Supplementation of poultry diets with DHQ under standard industry rearing conditions, did not improve performance or any of the studied variables, except an increase of redness index of the breast fillets. Feeding DHQ at different doses and/or under more challenging conditions, e.g. heat stress, may, however, bring positive responses

Effect of feeding different sources of selenium on growth performance and antioxidant status of broilers

This study was conducted to determine the effect of different sources of selenium (Se) on breast and liver tissue deposition, apparent metabolisable energy (AME), growth performance and antioxidant status of broilers, measured as Se content in liver and breast tissues and glutathione peroxidase (GSH-Px) in blood, when used in 0–35 d broiler chicken diets. 2. A total of 200 male Ross 308 broilers were used in the feeding trial, which comprised two dietary phases, a starter from 0 to 21 d and finisher from 21 to 35 d of age. Four treatments with 10 replications each were used. A control diet (C) was formulated that was sufficient in protein and energy (230 and 215 g/kg of crude protein and 12.67 and 13.11 MJ/kg of metabolisable energy, respectively), for both phases, but contained background Se only from the feed ingredients. The first treatment diet (IS) was made from the C diet supplemented with 10.35 g/t inorganic source of elemental Se in both feed phases. The third treatment (SY) was the control diet supplemented with 136.36 g/t selenised yeast (Sacchromyces cerevisiae) in both feed phases. A fourth treatment (SS) was the C diet supplemented with 0.666 g/t sodium selenite an inorganic source of Se in both starter and finisher diets. 3. Birds fed the SY diet consumed less and weighed less than those fed IS or C (P < 0.05; 0–35 d of age), but there was no difference compared to birds fed SS diets. There were no differences in FCR or dietary AME between broilers fed different Se sources. All diets containing supplementary Se increased concentrations in the liver and breast muscle, and for GSH-Px levels in blood compared to birds fed the C diet (P < 0.001). Birds fed SY diets had greater Se levels in liver and breast tissues compared to birds fed any of the other diets (P < 0.001). 4. Diets supplemented with Se had variable effects on broiler growth performances and antioxidant status. Feeding Se from a yeast source has higher transfer into breast tissues. Feeding different sources and levels of Se to birds in a more challenging situation to induce oxidative stress may bring more conclusive results

Feeding dihydroquercetin and vitamin E to broiler chickens reared at standard and high ambient temperatures

The use of natural antioxidants, in particular polyphenols such as dihydroquercetin (DHQ), in animal nutrition has recently increased in popularity. This may partly be due to the risk of increased incidences of heat stress associated with raising livestock in warmer ambient temperatures, facilitated by global warming, reducing antioxidant capacity. The current research demonstrates the effect of dietary DHQ, vitaminEand standard or high ambient temperatures on growth performance, energy and nutrient metabolism, gastrointestinal tract (GIT) development, jejunal villus morphometry and antioxidant status in broiler chickens. Each of the four experimental diets was fed to 16 pens of five birds, which were allocated to four rooms (four pens in each room). The temperature in two rooms was maintained at aconstant 35°C (high temperature; HT), and the temperature in the other two rooms was gradually reduced from 27°C at 7 dof age to 22°C at 20 dof age (standard temperature; ST). Rearing birds at HT reduced feed intake, weight gain, weight of small intestine, total GIT, liver, spleen, heart, villus height, villus surface area and lowered blood glutationperoxidase (GSH-Px). Dietary DHQ increased blood GSH-Px and total antioxidant status, increased heart weight and reduced caecal size. When fed separately, DHQ and vitamin E improved hepatic vitamin E concentration. Feeding vitamin Eincreased spleen and liver weights. When fed together, DHQ and vitamin Ereduced villus height, villus height to crypt depth ratio and villus surface area. Temperature and antioxidants did not affect energy and nutrient metabolism. There were no effects of dietary antioxidants on growth performance of broiler chickens and there were no mortalities. At present, it is unclear if feeding antioxidants (in particular DHQ) at different levels, using different dietary formulations, and rearing birds under arange of environmental conditions may be effective at enhancing production performance and bird health in hot ambient climates

Magnetic Field Generation in Stars

Enormous progress has been made on observing stellar magnetism in stars from the main sequence through to compact objects. Recent data have thrown into sharper relief the vexed question of the origin of stellar magnetic fields, which remains one of the main unanswered questions in astrophysics. In this chapter we review recent work in this area of research. In particular, we look at the fossil field hypothesis which links magnetism in compact stars to magnetism in main sequence and pre-main sequence stars and we consider why its feasibility has now been questioned particularly in the context of highly magnetic white dwarfs. We also review the fossil versus dynamo debate in the context of neutron stars and the roles played by key physical processes such as buoyancy, helicity, and superfluid turbulence,in the generation and stability of neutron star fields. Independent information on the internal magnetic field of neutron stars will come from future gravitational wave detections. Thus we maybe at the dawn of a new era of exciting discoveries in compact star magnetism driven by the opening of a new, non-electromagnetic observational window. We also review recent advances in the theory and computation of magnetohydrodynamic turbulence as it applies to stellar magnetism and dynamo theory. These advances offer insight into the action of stellar dynamos as well as processes whichcontrol the diffusive magnetic flux transport in stars.Comment: 41 pages, 7 figures. Invited review chapter on on magnetic field generation in stars to appear in Space Science Reviews, Springe

On the Crustal Matter of Magnetars

We have investigated some of the properties of dense sub-nuclear matter at the crustal region (both the outer crust and the inner crust region) of a magnetar. The relativistic version of Thomas-Fermi (TF) model is used in presence of strong quantizing magnetic field for the outer crust matter. The compressed matter in the outer crust, which is a crystal of metallic iron, is replaced by a regular array of spherically symmetric Wigner-Seitz (WS) cells. In the inner crust region, a mixture of iron and heavier neutron rich nuclei along with electrons and free neutrons has been considered. Conventional Harrison-Wheeler (HW) and Bethe-Baym-Pethick (BBP) equation of states are used for the nuclear mass formula. A lot of significant changes in the characteristic properties of dense crustal matter, both at the outer crust and the inner crust, have been observed.Comment: 29 pages REVTEX manuscript, 15 .eps figures (included

Lifetimes of High-Degree p Modes in the Quiet and Active Sun

We study variations of the lifetimes of high-degree solar p-modes in the quiet and active Sun with the solar activity cycle. The lifetimes in the degree range 300 - 600 and frequency 2.5 - 4.5 mHz were computed from SOHO/MDI data in an area including active regions and quiet Sun using the time-distance technique. We applied our analysis to the data in four different phases of solar activity: in 1996 (at minimum), 1998 (rising phase), 2000 (at maximum) and 2003 (declining phase). The results from the area with active regions show that the lifetime decreases as activity increases. The maximal lifetime variations are between solar minimum in 1996 and maximum in 2000; the relative variation averaged over all mode degree values and frequencies is a decrease of about 13%. The lifetime reductions relative to 1996 are about 7% in 1998 and about 10% in 2003. The lifetime computed in the quiet region still decreases with solar activity although the decrease is smaller. On average, relative to 1996, the lifetime decrease is about 4% in 1998, 10% in 2000 and 8% in 2003. Thus, measured lifetime increases when regions of high magnetic activity are avoided. Moreover, the lifetime computed in quiet regions also shows variations with activity cycle.Comment: 13 pages, 5 figures; Accepted for publication in Solar Physic

Big GABA II: Water-referenced edited MR spectroscopy at 25 research sites

Accurate and reliable quantification of brain metabolites measured in vivo using 1H magnetic resonance spectroscopy (MRS) is a topic of continued interest. Aside from differences in the basic approach to quantification, the quantification of metabolite data acquired at different sites and on different platforms poses an additional methodological challenge. In this study, spectrally edited γ-aminobutyric acid (GABA) MRS data were analyzed and GABA levels were quantified relative to an internal tissue water reference. Data from 284 volunteers scanned across 25 research sites were collected using GABA+ (GABA + co-edited macromolecules (MM)) and MM-suppressed GABA editing. The unsuppressed water signal from the volume of interest was acquired for concentration referencing. Whole-brain T1-weighted structural images were acquired and segmented to determine gray matter, white matter and cerebrospinal fluid voxel tissue fractions. Water-referenced GABA measurements were fully corrected for tissue-dependent signal relaxation and water visibility effects. The cohort-wide coefficient of variation was 17% for the GABA + data and 29% for the MM-suppressed GABA data. The mean within-site coefficient of variation was 10% for the GABA + data and 19% for the MM-suppressed GABA data. Vendor differences contributed 53% to the total variance in the GABA + data, while the remaining variance was attributed to site- (11%) and participant-level (36%) effects. For the MM-suppressed data, 54% of the variance was attributed to site differences, while the remaining 46% was attributed to participant differences. Results from an exploratory analysis suggested that the vendor differences were related to the unsuppressed water signal acquisition. Discounting the observed vendor-specific effects, water-referenced GABA measurements exhibit similar levels of variance to creatine-referenced GABA measurements. It is concluded that quantification using internal tissue water referencing is a viable and reliable method for the quantification of in vivo GABA levels