Lactate is associated with mortality in very old intensive care patients suffering from COVID-19: results from an international observational study of 2860 patients.

PURPOSE Lactate is an established prognosticator in critical care. However, there still is insufficient evidence about its role in predicting outcome in COVID-19. This is of particular concern in older patients who have been mostly affected during the initial surge in 2020. METHODS This prospective international observation study (The COVIP study) recruited patients aged 70 years or older (ClinicalTrials.gov ID: NCT04321265) admitted to an intensive care unit (ICU) with COVID-19 disease from March 2020 to February 2021. In addition to serial lactate values (arterial blood gas analysis), we recorded several parameters, including SOFA score, ICU procedures, limitation of care, ICU- and 3-month mortality. A lactate concentration ≥ 2.0 mmol/L on the day of ICU admission (baseline) was defined as abnormal. The primary outcome was ICU-mortality. The secondary outcomes 30-day and 3-month mortality. RESULTS In total, data from 2860 patients were analyzed. In most patients (68%), serum lactate was lower than 2 mmol/L. Elevated baseline serum lactate was associated with significantly higher ICU- and 3-month mortality (53% vs. 43%, and 71% vs. 57%, respectively, p < 0.001). In the multivariable analysis, the maximum lactate concentration on day 1 was independently associated with ICU mortality (aOR 1.06 95% CI 1.02-1.11; p = 0.007), 30-day mortality (aOR 1.07 95% CI 1.02-1.13; p = 0.005) and 3-month mortality (aOR 1.15 95% CI 1.08-1.24; p < 0.001) after adjustment for age, gender, SOFA score, and frailty. In 826 patients with baseline lactate ≥ 2 mmol/L sufficient data to calculate the difference between maximal levels on days 1 and 2 (∆ serum lactate) were available. A decreasing lactate concentration over time was inversely associated with ICU mortality after multivariate adjustment for SOFA score, age, Clinical Frailty Scale, and gender (aOR 0.60 95% CI 0.42-0.85; p = 0.004). CONCLUSION In critically ill old intensive care patients suffering from COVID-19, lactate and its kinetics are valuable tools for outcome prediction. TRIAL REGISTRATION NUMBER NCT04321265

Coronavirus-Pandemie: Die Feiertage und den Jahreswechsel für einen harten Lockdown nutzen : 7. Ad-hoc-Stellungnahme zr Coronavirus-Pandemie - 08.Dezember 2020

Die gegenwärtige Situation ist nach wie vor ernst und droht sich weiter zu verschärfen. Trotz des seit Anfang November in Deutschland geltenden Teil-Lockdowns sind die Infektionszahlen auf einem sehr hohen Niveau. Jeden Tag sterben mehrere Hundert Menschen. Die Krankenhäuser und insbesondere das medizinische Personal sind bereits jetzt an ihren Grenzen und die Gesundheitsämter überlastet. Um die Kontrolle über das Infektionsgeschehen zurückzuerlangen, empfiehlt die Nationale Akademie der Wissenschaften Leopoldina in der Ad-hoc-Stellungnahme „Coronavirus-Pandemie: Die Feiertage und den Jahreswechsel für einen harten Lockdown nutzen“ ein zweistufiges Vorgehen. Die Rahmenbedingungen ‒ Weihnachtsferien in Bildungseinrichtungen und eingeschränkter Betrieb in vielen Unternehmen und Behörden – bieten die Chance, in der Eindämmung der Pandemie ein großes Stück voranzukommen

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

An Optimization Model for Technology Adoption of Marginalized Smallholders: Theoretical Support for Matching Technological and Institutional Innovations

The rural poor are often marginalized and restricted from access to markets, public services and information, mainly due to poor connections to transport and communication infrastructure. Despite these unfavorable conditions, agricultural technology investments are believed to unleash unused human and natural capital potentials and alleviate poverty by productivity growth in agriculture. Based on the concept of marginality we develop a theoretical model which shows that these expectations for productivity growth are conditional on human and natural capital stocks and transaction costs. Our model categorizes the rural farm households below the poverty line into four segments according to labor and land endowments. Policy recommendations for segment and location specific investments are provided. Theoretical findings indicate that adjusting rural infrastructure and institutions to reduce transaction costs is a more preferable investment strategy than adjusting agricultural technologies to marginalized production conditions

Methodological Review and Revision of the Global Hunger Index

The Global Hunger Index (GHI) is a multidimensional measure of hunger that considers three dimensions: (1) inadequate dietary energy supply, (2) child undernutrition, and (3) child mortality. The initial version of the index included the following three, equally weighted, non-standardized (i.e. unscaled) indicators that are expressed in percent: the proportion of the population that is calorie deficient (FAO's prevalence of undernourishment); the prevalence of underweight in children under five; and the under-five mortality rate. Several decisions regarding the original formulation of the GHI are reconsidered in light of recent discussions in the nutrition community and suggestions by other researchers, namely the choice of the prevalence of child underweight for the child undernutrition dimension, the use of the under-five mortality rate from all causes for the child mortality dimension, and the decision not to standardize the component indicators prior to aggregation. Based on an exploration of the literature, data availability and comparability across countries, and correlation analyses with indicators of micronutrient deficiencies, the index is revised as follows: (1) The child underweight indicator is replaced with child stunting and child wasting; (2) The weight of one third for the child undernutrition dimension is shared equally between the two new indicators; and (3) The component indicators of the index are standardized prior to aggregation, using fixed thresholds set above the maximum values observed in the data set. The under-five mortality rate from all causes is retained, because estimating under-five mortality attributable to nutritional deficiencies would be very costly and make the production of the GHI dependent on statistics about cause-specific mortality rates by country and year that are published irregularly, while the expected benefits are limited

Institutional Environments for Enabling Agricultural Technology Innovations: The Role of Land Rights in Ethiopia, Ghana, India and Bangladesh

Land rights are essential assets for improving the livelihoods of the rural poor. This literature based paper shed light to some land rights issues that are crucial for the effectiveness and sustainability of implementing technological innovations in marginalized rural areas of Ethiopia, Ghana, India and Bangladesh. By analysing country specific land right regimes, this paper aims to understand what institutional conditions might constitute barriers to the effective implementation of technological innovations and how they might be overcome. Land rights issues considered in this paper include public and private ownership of land in Ethiopia, customary and statutory law in Ghana, and gender equality and land rights in India and Bangladesh. A better understanding of institutional barriers for the effective implementation of technological innovations is a precondition for complementing technological with enabling institutional innovations and for improving priority setting, targeting and sequencing in the implementation of productivity increasing development measures

Between Hope and Hype: Traditional Knowledge(s) Held by Marginal Communities

Traditional Knowledge (TK) systems have always been integral to the survival and adaptation of human societies. Yet, they enjoy a fairly recent recognition and popularization by scientists, the media, politicians, corporates and the wider public. In this paper we present a typology of key driving forces behind the popularization of TK held by marginal communities: an equality preference motive, a value motive, a compliance motive, a scarcity motive and a strategic motive. Secondly, through the use of a simple model, we discuss the hype's impact on marginal communities. Moreover, we critically assess the outcome of a number of policy instruments that intend, in part, to protect traditional knowledge bases of such communities. Our analysis primarily draws upon secondary literature; policy documents and case studies within economics, the social sciences, conservation biology and legal studies. We argue that whilst the public and institutional hype around TK may have resulted in its prioritization within international conventions and frameworks, its institutionalization may have adversely impacted marginalized communities, and in particular contexts, unintentionally led to the creation of 'new' marginals. We purport that the traditional innovation incentive motive does not hold for protecting TK within a private property regime. Instead we identify a conservation incentive motive and a distribution motive that justify deriving policy instruments that focus on TK to protect marginal communities

Social Safety Nets for Food and Nutritional Security in India

This paper brings together existing literature on the Mahatma Gandhi National Rural Employment Guarantee Act (MGNRGEA) and the Public Distribution System (PDS) in India, offering a narrative review of the evidence on impacts on food security, health and nutrition of beneficiaries. Both programs operate on a large scale and have the capacity to impact the factors leading to undernutrition. It is evident that despite the deficiencies in implementation, both the MGNREGA and the PDS are inclusive and reach the poor and the marginalized who are likely to also experience greater undernutrition and poor health. Data challenges have however prevented researchers from conducting studies that assess the ultimate impact of these two large-scale programs on health and nutrition. The evidence that exists suggests largely positive impacts indicating a clear potential to make these programs more nutrition sensitive not just by incorporating elements that would explicitly address nutritional concerns but also by directing specific attention to innovations that strengthen critical complementarities and synergies that exist between the two programs

Food and Nutrition Security Indicators: A Review

In this paper, we review existing food and nutrition security indicators, discuss some of their advantages and disadvantages, and finally classify them and describe their relationships and overlaps. In order to achieve this, the paper makes reference to the existing definitions of food and nutrition security (FNS), in particular as they have been agreed upon and implemented in the FoodSecure project (www.foodsecure.eu). The main existing conceptual frameworks of FNS predating the present paper are also used as guidelines and briefly discussed. Finally, we make recommendations in terms of the most appropriate FNS indicators to quantify the impacts of various shocks and interventions on food and nutrition security outcomes