Correlation of the Boost Risk Stratification Tool as a Predictor of Unplanned 30-Day Readmission in Elderly Patients

Carol K. Sieck Loyola University Chicago CORRELATION OF THE BOOST RISK STRATIFICATION TOOL AS A PREDICTOR OF UNPLANNED 30-DAY REAMDISSION IN ELDERLY PATIENTS Risk stratification tools can identify patients at risk for 30-day readmission but available tools lack predictive strength. While physical, functional and social determinants of health have demonstrated an association with readmission, available risk stratification tools have been inconsistent in their use of variables to predict readmission. The Better Outcomes by Optimizing Safe Transitions (BOOST) 8 P\u27s tool is a risk stratification tool developed by the Society of Hospital Medicine but has no published validation studies. The theoretical foundation used for this study was Wagner\u27s Care Model that illustrates the interconnected nature of acute and preventive care needed by chronically ill patients over a lifetime. This quantitative study using secondary data to measure the degree to which the BOOST variables predict 30-day readmission. The sample included one year of hospitalized patients 65+ (n=6849) from a tertiary hospital in the Midwest. Univariate and multivariate logistic regression demonstrated that six of the eight variables in the BOOST risk stratification tool showed significant predictive strength, including the social variables of health literacy (p=.030), depression (p=.003) and isolation (p=.011). Other significant variables included problem medications (p=.001), physical limitations (p=\u3c.001) and prior hospitalization (p=\u3c.001). The BOOST risk stratification tool had limited predictive capability with a C-statistic of .631. This study was the first attempt to validate the BOOST 8 P\u27s tool and to utilize nursing documentation within an electronic medical record to capture social determinants of health. Implications for nursing practice include the need for nurses to gain skills in using risk stratification tools to identify patients at risk for readmission to target preventive interventions including care coordination efforts. Future research should target variables, especially social factors of depression, health literacy and isolation to predict 30-day readmission, especially for the growing population of elderly patients with chronic illness

Case study for the assessment of the biogeophysical effects of a potential afforestation in Europe

BACKGROUND: A regional-scale sensitivity study has been carried out to investigate the climatic effects of forest cover change in Europe. Applying REMO (regional climate model of the Max Planck Institute for Meteorology), the projected temperature and precipitation tendencies have been analysed for summer, based on the results of the A2 IPCC-SRES emission scenario simulation. For the end of the 21st century it has been studied, whether the assumed forest cover increase could reduce the effects of the greenhouse gas concentration change. RESULTS: Based on the simulation results, biogeophysical effects of the hypothetic potential afforestation may lead to cooler and moister conditions during summer in most parts of the temperate zone. The largest relative effects of forest cover increase can be expected in northern Germany, Poland and Ukraine, which is 15-20% of the climate change signal for temperature and more than 50% for precipitation. In northern Germany and France, potential afforestation may enhance the effects of emission change, resulting in more severe heavy precipitation events. The probability of dry days and warm temperature extremes would decrease. CONCLUSIONS: Large contiguous forest blocks can have distinctive biogeophysical effect on the climate on regional and local scale. In certain regions of the temperate zone, climate change signal due to greenhouse gas emission can be reduced by afforestation due to the dominant evaporative cooling effect during summer. Results of this case study with a hypothetical land cover change can contribute to the assessment of the role of forests in adapting to climate change. Thus they can build an important basis of the future forest policy

Beta-adrenergic agonists increase maximal output of oxidative phosphorylation in bovine satellite cells

Beta-adrenergic agonists (βAA), Ractopamine HCl (RH) and Zilpaterol HCl (ZH), are FDAapproved supplements utilized in pigs and cattle to improve growth performance, carcass weight, and longissimus muscle area (Arp et al., 2014; Lean et al., 2014). Previous studies within our group have focused on understanding molecular changes in skeletal muscle due to βAA supplementation. This work has shown that βAA supplementation increases glucose oxidation in muscle from thermoneutral and heat-stressed lambs (Barnes et al., 2019) and in rat skeletal muscle stimulated with ZH (Cadaret et al., 2017). Skeletal muscle transcriptomics of lambs supplemented ZH revealed upregulation of genes associated with the callipyge phenotype of sheep (Yu et al., 2018) as well as the upregulation of mitochondrial solute carrier SLC25A25 (Kubik et al., 2018). SLC25A25 is a Ca2+ sensitive ATP-Mg2+/Pi inner mitochondrial membrane solute transporter. Due to the role of the mitochondria in metabolism and the results of prior transcriptomics studies, the objective of this study was to understand how βAA affect mitochondrial function of bovine skeletal muscle stem (i.e., satellite) cells. We hypothesized that βAA would improve efficiency and ATP production capacity of muscle stem cells by modifying mitochondrial function

Beta-adrenergic agonists alter oxidative phosphorylation in primary myoblasts (Short Communication)

Beta-adrenergic agonists (β-AAs) are widely used supplements in beef and pork production to improve feed efficiency and increase lean muscle mass, yet little is known about the molecular mechanism by which β-AAs achieve this outcome. Our objective was to identify the influence of ractopamine HCl and zilpaterol HCl on mitochondrial respiratory activity in muscle satellite cells isolated from crossbred beef steers (N = 5), crossbred barrows (N = 2), Yorkshire-cross gilts (N = 3), and commercial weather lambs (N = 5). Real-time measurements of oxygen con­sumption rates (OCRs) were recorded using extracellular flux analyses with a Seahorse XFe24 analyzer. After basal OCR measurements were recorded, zilpaterol HCl, ractopamine HCl, or no β-AA was injected into the assay plate in three technical replicates for each cell isolate. Then, oligomycin, carbonyl cyanide-p-trifluoromethoxyphenylhydrazone, and rotenone were injected into the assay plate sequentially, each inducing a different cellular state. This allowed for the measurement of OCR at these states and for the calculation of the following measures of mitochon­drial function: basal respiration, non-mitochondrial respiration, maximal respiration, proton leak, adenosine triphosphate (ATP)-linked respiration, and spare respiratory capacity. Incubation of bovine cells with either zilpaterol HCl or ractopamine HCl increased maximal respiration (P = 0.046) and spare respiratory capacity (P = 0.035) compared with non-supplemented counterparts. No difference (P \u3e 0.05) was observed between zilpaterol HCl and ractopamine HCl for maximal respiration and spare respiratory capacity in bovine cell isolates. No measures of mitochondrial function (basal respiration, non-mitochondrial respiration, maximal respiration, proton leak, ATP-linked respiration, and spare respiratory capacity) were altered by β-AA treatment in ovine or porcine cells. These findings indicate that β-AAs in cattle may improve the efficiency of oxidative metabolism in muscle satellite cells by modifying mitochondrial respiratory activity. The lack of response by ovine and porcine cells to β-AA incubation also demonstrates differing physiological responses to β-AA across species, which helps to explain the variation in its effectiveness as a growth supplement. Lay Summary — Beta-adrenergic agonists (β-AAs) are supplemented to pigs and cattle to improve growth performance, carcass weight, and loin muscle area. Little is known about the mechanism taking place within individual cells by which β-AAs achieve this outcome. Previous work reported that β-AA supplementation improves the efficiency in which cells use glucose as an energy source and alters the expression of genes related to mitochondrial function, a key component of cellular energy production. To further our understanding of the impact of β-AA supplementation on these cellular functions, our objective was to identify the influence of two β-AAs used in livestock production, ractopamine HCl and zilpaterol HCl, on the mitochondrial respiratory activity of cells collected from the loin muscle and grown in culture. We isolated cells from cattle, pig, and sheep muscle and measured the oxygen consumption of the cells after treatment with ractopamine HCl, zilpaterol HCl, or with no supplement. We found that both ractopamine HCl and zilpaterol HCl enhance the efficiency of cellular energy production during a state of cellular stress in bovine muscle cells. There was no appreciable effect of the supplement on the energy production of pig or sheep cells. These data indicate that β-AA supplementation in cattle may increase the muscle cell energy production capacity compared with non-supplemented cells. This study also demonstrates that the efficiency of cell energy production is one plausible mechanism underlying species differences in the response to β-AA supplementation

The role of forests in mitigating climate change - A case study for Europe

A regional-scale case study has been carried out to assess the possible climatic benefits of forest cover increase in Europe. For the end of the 21st century (2071-2090) it has been investigated, whether the projected climate change could be reduced assuming potential afforestation of the continent. The magnitude of the biogeophysical effects of enhanced forest cover on temperature and precipitation means and extremes have been analyzed relative to the magnitude of the climate change signal applying the regional climate model REMO. The simulation results indicate that in the largest part of the temperate zone potential afforestation may reduce the projected climate change through cooler and moister conditions, thus could contribute to the mitigation of the projected climate change for the entire summer period. The largest relative effect of forest cover increase can be expected in northern Germany, Poland and Ukraine. Here, the projected precipitation decrease could be fully compensated, the temperature increase could be relieved by up to 0.5 degrees C, and the probability of extremely warm and dry days could be reduced. Results can help to identify the areas, where forest cover increase could be the most effective from climatic point of view. Thus they can build an important basis of the future adaptation strategies and forest policy

Assessing the transferability of the regional climate model REMO to different COordinated Regional Climate Downscaling EXperiment (CORDEX) Regions

The transferability of the regional climate model REMO with a standard setup over different regions of the world has been evaluated. The study is based on the idea that the modeling parameters and parameterizations in a regional climate model should be robust to adequately simulate the major climatic characteristic of different regions around the globe. If a model is not able to do that, there might be a chance of an “overtuning” to the “home-region”, which means that the model physics are tuned in a way that it might cover some more fundamental errors, e.g., in the dynamics. All simulations carried out in this study contribute to the joint effort by the international regional downscaling community called COordinated Regional climate Downscaling EXperiment (CORDEX). REMO has been integrated over six CORDEX domains forced with the so-called perfect boundary conditions obtained from the global reanalysis dataset ERA-Interim for the period 1989 to 2008. These six domains include Africa, Europe, North America, South America, West Asia and the Mediterranean region. Each of the six simulations was conducted with the identical model setup which allows investigating the transferability of a single model to regions with substantially different climate characteristics. For the consistent evaluation over the different domains, a new evaluation framework is presented by combining the Köppen-Trewartha climate classification with temperature-precipitation relationship plots and a probability density function (PDF) skill score method. The evaluation of the spatial and temporal characteristics of simulated precipitation and temperature, in comparison to observational datasets, shows that REMO is able to simulate the mean annual climatic features over all the domains quite reasonably, but still some biases remain. The regions over the Amazon and near the coast of major upwelling regions have a significant warm bias. Wet and dry biases appear over the mountainous regions and East Africa, respectively. The temperature over South America and precipitation over the tundra and highland climate of West Asia are misrepresented. The probable causes leading to these biases are discussed and ideas for improvements are suggested. The annual cycle of precipitation and temperature of major catchments in each domain are also well represented by REMO. The model has performed well in simulating the inter- and intra-seasonal characteristics of different climate types in different regions. Moreover, the model has a high ability in representing the general characteristics of different climate types as measured by the probability density function (PDF) skill score method. Although REMO seems to perform best over its home domain in Europe (domain of development and testing), the model has simulated quite well the climate characteristics of other regions with the same set of parameterization options. Therefore, these results lead us to the conclusion that REMO is well suited for long-term climate change simulations to examine projected future changes in all these regions

Mandibulofacial Dysostosis Attributed to a Recessive Mutation of CYP26C1 in Hereford Cattle

In spring 2020, six Hereford calves presented with congenital facial deformities attributed to a condition we termed mandibulofacial dysostosis (MD). Affected calves shared hallmark features of a variably shortened and/or asymmetric lower mandible and bilateral skin tags present 2–10 cm caudal to the commissure of the lips. Pedigree analysis revealed a single common ancestor shared by the sire and dam of each affected calf. Whole-genome sequencing (WGS) of 20 animals led to the discovery of a variant (Chr26 g. 14404993T\u3eC) in Exon 3 of CYP26C1 associated with MD. This missense mutation (p.L188P), is located in an α helix of the protein, which the identified amino acid substitution is predicted to break. The implication of this mutation was further validated through genotyping 2 additional affected calves, 760 other Herefords, and by evaluation of available WGS data from over 2500 other individuals. Only the a_ected individuals were homozygous for the variant and all heterozygotes had at least one pedigree tie to the suspect founder. CYP26C1 plays a vital role in tissue-specific regulation of retinoic acid (RA) during embryonic development. Dysregulation of RA can result in teratogenesis by altering the endothelin-1 signaling pathway affecting the expression of Dlx genes, critical to mandibulofacial development. We postulate that this recessive missense mutation in CYP26C1 impacts the catalytic activity of the encoded enzyme, leading to excess RA resulting in the observed MD phenotype

Heat stress and β-adrenergic agonists alter the adipose transcriptome and fatty acid mobilization in ruminant livestock

Growth and feed efficiency of cattle are improved by supplementation with the beta-adrenergic agonists (βAA), ractopamine hydrochloride (RH; β1AA) or zilpaterol hydrochloride (ZH; β2AA) (Elam et al., 2009). βAA supplementation alters adipose deposition by inhibiting fatty acid biosynthesis and promoting lipolysis of stored triacylglycerols into free fatty acids (FFAs) (Johnson et al., 2014). However, β2 adrenoceptors (βAR) desensitize with chronic activation (Re et al., 1997); supplementation is thus limited to the last 20 to 40 d of feeding. The annual economic impact of heat stress (HS) has been estimated to exceed $2.4 billion (St-Pierre et al., 2003). Heat-stressed livestock have reduced growth rates, dry matter intake, and average daily gain (Mitlöhner et al., 2001; St-Pierre et al., 2003). In response to acute stress, signaling pathways for lipolysis of circulating and stored triglycerides are activated, while chronic stress increases lipogenesis and adipogenesis (Campbell et al., 2009; Peckett et al., 2011). In cattle, HS also increases the responsiveness of adipocytes to lipolytic signals, increasing lipolysis (Faylon et al., 2015). The objective of this study was to understand how HS and βAA independently and interactively affect adipose tissue. Prior work identified minimal impact of RH on metabolic properties (Barnes et al., 2019) and on the transcriptome of skeletal muscle (Kubik et al., 2018). We therefore hypothesized that RH may be primarily affecting adipose; specifically, that lipolytic activity is increased due to heat and βAA in an additive fashion. We tested this hypothesis in RH-supplemented lambs and ZH-supplemented cattle exposed to HS for 30 and 21 d, respectively