Epidemiology and association with outcomes of polypharmacy in patients undergoing surgery: retrospective, population-based cohort study

BACKGROUND: The aim of this study was to determine the prevalence of preoperative polypharmacy and the incidence of postoperative polypharmacy/hyper-polypharmacy in surgical patients and their association with adverse outcomes. METHODS: This was a retrospective, population-based cohort study among patients older than or equal to 18 years undergoing surgery at a university hospital between 2005 and 2018. Patients were categorized based on the number of medications: non-polypharmacy (fewer than 5); polypharmacy (5-9); and hyper-polypharmacy (greater than or equal to 10). The 30-day mortality, prolonged hospitalization (greater than or equal to 10 days), and incidence of readmission were compared between medication-use categories. RESULTS: Among 55 997 patients, the prevalence of preoperative polypharmacy was 32.3 per cent (95 per cent c.i. 33.5 to 34.3) and the prevalence of hyper-polypharmacy was 25.5 per cent (95 per cent c.i. 25.2 to 25.9). Thirty-day mortality was higher for patients exposed to preoperative hyper-polypharmacy (2.3 per cent) and preoperative polypharmacy (0.8 per cent) compared with those exposed to non-polypharmacy (0.6 per cent) (P < 0.001). The hazards ratio (HR) of long-term mortality was higher for patients exposed to hyper-polypharmacy (HR 1.32 (95 per cent c.i. 1.25 to 1.40)) and polypharmacy (HR 1.07 (95 per cent c.i. 1.01 to 1.14)) after adjustment for patient and procedural variables. The incidence of longer hospitalization (greater than or equal to 10 days) was higher for hyper-polypharmacy (11.3 per cent) and polypharmacy (6.3 per cent) compared with non-polypharmacy (4.1 per cent) (P < 0.001). The 30-day incidence of readmission was higher for patients exposed to hyper-polypharmacy (10.2 per cent) compared with polypharmacy (6.1 per cent) and non-polypharmacy (4.8 per cent) (P < 0.001). Among patients not exposed to polypharmacy, the incidence of new postoperative polypharmacy/hyper-polypharmacy was 33.4 per cent (95 per cent c.i. 32.8 to 34.1), and, for patients exposed to preoperative polypharmacy, the incidence of postoperative hyper-polypharmacy was 16.3 per cent (95 per cent c.i. 16.0 to 16.7). CONCLUSION: Preoperative polypharmacy and new postoperative polypharmacy/hyper-polypharmacy are common and associated with adverse outcomes. This highlights the need for increased emphasis on optimizing medication usage throughout the perioperative interval

Impact of obesity on surgical outcomes following coronary artery bypass graft surgery

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Introduction: Obesity has been related to increased postoperative morbidity and mortality following open-heart surgery. However, recent studies have shown no association or even a more favourable outcome in obese patients. This relationship was investigated in a well-defined cohort of patients that underwent myocardial revascularisation in Iceland. Material and methods: A retrospective study including all patients that underwent isolated myocardial revascularisation in Iceland from 2002 to 2006. Alltogether 720 patients were divided into two groups, an obese group, with BMI >30 kg/m2 (n=207, 29%), and a non-obese group with BMI ≤30 kg/m2 (n=513, 71%). Patient demographics, complications, operative mortality and long term survival of both groups were compared. Results: Demographics were comparable between the groups. Obese patients were 2.4 years younger, more likely to use statins (83,3% vs. 71,2%, had a significantly lower EuroSCORE (4.3 vs. 5.0) but a slightly longer operation time. Pleural fluid was less often drained in obese patients (8.2 vs. 15.0%) but rates for other complications were similar in both groups, as was operative mortality ≤30 days (2.0% vs. 3.7%), 1 and 5 year survival. In a multivariate analysis obesity was not an independent risk factor for minor or major complications, operative mortality or long term survival. Conclusion: The rate of complications and operative mortality after myocardial revascularisation is not significantly higher in obese patients and the same applies to long term survival. This is true even after correcting for confounding factors in a multivariate analysis.Tilgangur: Offita hefur almennt verið talin auka tíðni fylgikvilla eftir skurðaðgerðir. Niðurstöður rannsókna á tengslum offitu við opnar hjartaaðgerðir eru þó misvísandi og til eru rannsóknir sem sýna sambærilega og jafnvel lægri tíðni fylgikvilla. Tilgangur þessarar rannsóknar var að kanna tengsl offitu við árangur kransæðahjáveituaðgerða á Íslandi. Efniviður og aðferðir: Afturskyggn rannsókn á 720 sjúklingum sem gengust undir kransæðahjáveituaðgerð á Landspítala frá 2002-2006. Sjúklingum var skipt í tvo hópa; offituhóp með líkams-þyngdarstuðul >30 kg/m2 (n=207, 29%), og viðmiðunarhóp með stuðulinn £30 kg/m2 (n=513, 71%). Hóparnir voru bornir saman með ein- og fjölþáttagreiningu og áhrif offitu metin með tilliti til tíðni fylgikvilla, skurðdauða £30 daga og langtíma lífshorfa. Niðurstöður: Áhættuþættir hjarta- og kransæðasjúkdóma voru sambærilegir í báðum hópum en sjúklingar í offituhópi tóku oftar blóðfitulækkandi lyf (83,3% sbr. 71,2%, voru 2,4 árum yngri, með lægra EuroSCORE (4,3 sbr. 5,0) en aðeins lengri aðgerðartíma. Sjaldnar þurfti að tappa af fleiðruvökva í offituhópi (8,2% sbr. 15,0%), en annars var tíðni fylgikvilla og dánartíðni £30 daga (2,0% sbr. 3,7%) sambærileg. Við fjölþáttagreiningu reyndist offita ekki sjálfstæður áhættuþáttur minniháttar fylgikvilla, alvarlegra fylgikvilla, dánartíðni £30 daga eða langtíma lífshorfa. Ályktun: Fylgikvillar og dánartíðni eftir kransæðahjáveituaðgerð reyndust ekki marktækt aukin hjá offitusjúklingum, jafnvel eftir að leiðrétt var fyrir hugsanlegri valbjögun, eins og lægra EuroSCORE, aldri og notkun statínlyfja í offituhópi. Langtímalifun virðist einnig sambærileg

The population genomic legacy of the second plague pandemic

SummaryHuman populations have been shaped by catastrophes that may have left long-lasting signatures in their genomes. One notable example is the second plague pandemic that entered Europe in ca. 1,347 CE and repeatedly returned for over 300 years, with typical village and town mortality estimated at 10%–40%.1 It is assumed that this high mortality affected the gene pools of these populations. First, local population crashes reduced genetic diversity. Second, a change in frequency is expected for sequence variants that may have affected survival or susceptibility to the etiologic agent (Yersinia pestis).2 Third, mass mortality might alter the local gene pools through its impact on subsequent migration patterns. We explored these factors using the Norwegian city of Trondheim as a model, by sequencing 54 genomes spanning three time periods: (1) prior to the plague striking Trondheim in 1,349 CE, (2) the 17th–19th century, and (3) the present. We find that the pandemic period shaped the gene pool by reducing long distance immigration, in particular from the British Isles, and inducing a bottleneck that reduced genetic diversity. Although we also observe an excess of large FST values at multiple loci in the genome, these are shaped by reference biases introduced by mapping our relatively low genome coverage degraded DNA to the reference genome. This implies that attempts to detect selection using ancient DNA (aDNA) datasets that vary by read length and depth of sequencing coverage may be particularly challenging until methods have been developed to account for the impact of differential reference bias on test statistics.Results and discussion STAR★Method

Impact of obesity on surgical outcomes following coronary artery bypass graft surgery

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Introduction: Obesity has been related to increased postoperative morbidity and mortality following open-heart surgery. However, recent studies have shown no association or even a more favourable outcome in obese patients. This relationship was investigated in a well-defined cohort of patients that underwent myocardial revascularisation in Iceland. Material and methods: A retrospective study including all patients that underwent isolated myocardial revascularisation in Iceland from 2002 to 2006. Alltogether 720 patients were divided into two groups, an obese group, with BMI >30 kg/m2 (n=207, 29%), and a non-obese group with BMI ≤30 kg/m2 (n=513, 71%). Patient demographics, complications, operative mortality and long term survival of both groups were compared. Results: Demographics were comparable between the groups. Obese patients were 2.4 years younger, more likely to use statins (83,3% vs. 71,2%, had a significantly lower EuroSCORE (4.3 vs. 5.0) but a slightly longer operation time. Pleural fluid was less often drained in obese patients (8.2 vs. 15.0%) but rates for other complications were similar in both groups, as was operative mortality ≤30 days (2.0% vs. 3.7%), 1 and 5 year survival. In a multivariate analysis obesity was not an independent risk factor for minor or major complications, operative mortality or long term survival. Conclusion: The rate of complications and operative mortality after myocardial revascularisation is not significantly higher in obese patients and the same applies to long term survival. This is true even after correcting for confounding factors in a multivariate analysis.Tilgangur: Offita hefur almennt verið talin auka tíðni fylgikvilla eftir skurðaðgerðir. Niðurstöður rannsókna á tengslum offitu við opnar hjartaaðgerðir eru þó misvísandi og til eru rannsóknir sem sýna sambærilega og jafnvel lægri tíðni fylgikvilla. Tilgangur þessarar rannsóknar var að kanna tengsl offitu við árangur kransæðahjáveituaðgerða á Íslandi. Efniviður og aðferðir: Afturskyggn rannsókn á 720 sjúklingum sem gengust undir kransæðahjáveituaðgerð á Landspítala frá 2002-2006. Sjúklingum var skipt í tvo hópa; offituhóp með líkams-þyngdarstuðul >30 kg/m2 (n=207, 29%), og viðmiðunarhóp með stuðulinn £30 kg/m2 (n=513, 71%). Hóparnir voru bornir saman með ein- og fjölþáttagreiningu og áhrif offitu metin með tilliti til tíðni fylgikvilla, skurðdauða £30 daga og langtíma lífshorfa. Niðurstöður: Áhættuþættir hjarta- og kransæðasjúkdóma voru sambærilegir í báðum hópum en sjúklingar í offituhópi tóku oftar blóðfitulækkandi lyf (83,3% sbr. 71,2%, voru 2,4 árum yngri, með lægra EuroSCORE (4,3 sbr. 5,0) en aðeins lengri aðgerðartíma. Sjaldnar þurfti að tappa af fleiðruvökva í offituhópi (8,2% sbr. 15,0%), en annars var tíðni fylgikvilla og dánartíðni £30 daga (2,0% sbr. 3,7%) sambærileg. Við fjölþáttagreiningu reyndist offita ekki sjálfstæður áhættuþáttur minniháttar fylgikvilla, alvarlegra fylgikvilla, dánartíðni £30 daga eða langtíma lífshorfa. Ályktun: Fylgikvillar og dánartíðni eftir kransæðahjáveituaðgerð reyndust ekki marktækt aukin hjá offitusjúklingum, jafnvel eftir að leiðrétt var fyrir hugsanlegri valbjögun, eins og lægra EuroSCORE, aldri og notkun statínlyfja í offituhópi. Langtímalifun virðist einnig sambærileg

Data from: Functional diversity of Collembola is reduced in soils subjected to short-term, but not long-term, geothermal warming

1. Human activities have caused global changes of atmospheric chemistry resulting in increased temperature especially in the colder regions of the northern hemisphere. Since warming of the environment can have drastic effects on terrestrial ecosystems it is important to experimentally evaluate the extent of such effects in long-term field-based experiments. In the present study we make use of both recent (short-term) and long-term geothermal warming of Icelandic soils to examine the responses of Collembola, an ecologically important group of soil invertebrates, to warming. 2. Based on metabolic scaling theory, we hypothesized that species of small size would be more successful in warmed soils than species of larger size. Further we expected that top-soil dwelling species would benefit more from warming than deep-soil dwelling species. In order to test these hypotheses we sampled Collembola along replicated gradients of increasing temperature in areas that had been heated for about six years and more than 50 years, respectively. Collembola were identified to species level, counted, and the community-weighted mean trait scores for six functional and ecological traits were calculated. 3. Results show that both short-term and long-term soil warming caused a shift towards a higher relative abundance of species with small body size. Further, abundance of top-soil dwelling Collembola tended to increase after short-term warming, but the opposite was observed after long-term warming. 4. Using trait-based diversity indices (Frich and RaoQ), we show that functional richness and diversity of Collembola communities was significantly reduced (almost halved) as a result of short-term soil warming to about 10 °C above normal, but this effect was not detected in plots equally warmed for more than 50 years. This indicates that the functional diversity of Collembola communities have high resilience towards soil warming in a long-term perspective

Geothermal ecosystems as natural climate change experiments : the ForHot research site in Iceland as a case study

Imbalance-P paper. Contact with Bjarni D.Sigurdsson This article describes how natural geothermal soil temperature gradients in Iceland have been used to study terrestrial ecosystem responses to soil warming. The experimental approach was evaluated at three study sites in southern Iceland; one grassland site that has been warm for at least 50 years (GO), and another comparable grassland site (GN) and a Sitka spruce plantation (FN) site that have both been warmed since an earthquake took place in 2008. Within each site type, five ca. 50 m long transects, with six permanent study plots each, were established across the soil warming gradients, spanning from unwarmed control conditions to gradually warmer soils. It was attempted to select the plots so the annual warming levels would be ca. +1, +3, +5, +10 and +20 °C within each transect. Results of continuous measurements of soil temperature (Ts) from 2013-2015 revealed that the soil warming was relatively constant and followed the seasonal Ts cycle of the unwarmed control plots. Volumetric water content in the top 5 cm of soil was repeatedly surveyed during 2013-2016. The grassland soils were wetter than the FN soils, but they had sometimes some significant warming-induced drying in the surface layer of the warmest plots, in contrast to FN. Soil chemistry did not show any indications that geothermal water had reached the root zone, but soil pH did increase somewhat with warming, which was probably linked to vegetation changes. As expected, the potential decomposition rate of organic matter increased significantly with warming. It was concluded that the natural geothermal gradients at the ForHot sites in Iceland offered realistic conditions for studying terrestrial ecosystem responses to warming with minimal artefacts

Rapid shifting of a deep magmatic source at Fagradalsfjall volcano, Iceland

AbstractRecent Icelandic rifting events have illuminated the roles of centralized crustal magma reservoirs and lateral magma transport1–4, important characteristics of mid-ocean ridge magmatism1,5. A consequence of such shallow crustal processing of magmas4,5 is the overprinting of signatures that trace the origin, evolution and transport of melts in the uppermost mantle and lowermost crust6,7. Here we present unique insights into processes occurring in this zone from integrated petrologic and geochemical studies of the 2021 Fagradalsfjall eruption on the Reykjanes Peninsula in Iceland. Geochemical analyses of basalts erupted during the first 50 days of the eruption, combined with associated gas emissions, reveal direct sourcing from a near-Moho magma storage zone. Geochemical proxies, which signify different mantle compositions and melting conditions, changed at a rate unparalleled for individual basaltic eruptions globally. Initially, the erupted lava was dominated by melts sourced from the shallowest mantle but over the following three weeks became increasingly dominated by magmas generated at a greater depth. This exceptionally rapid trend in erupted compositions provides an unprecedented temporal record of magma mixing that filters the mantle signal, consistent with processing in near-Moho melt lenses containing 107–108 m3 of basaltic magma. Exposing previously inaccessible parts of this key magma processing zone to near-real-time investigations provides new insights into the timescales and operational mode of basaltic magma systems.</jats:p

Does Presence of a Mid-Ocean Ridge Enhance Biomass and Biodiversity?

In contrast to generally sparse biological communities in open-ocean settings, seamounts and ridges are perceived as areas of elevated productivity and biodiversity capable of supporting commercial fisheries. We investigated the origin of this apparent biological enhancement over a segment of the North Mid-Atlantic Ridge (MAR) using sonar, corers, trawls, traps, and a remotely operated vehicle to survey habitat, biomass, and biodiversity. Satellite remote sensing provided information on flow patterns, thermal fronts, and primary production, while sediment traps measured export flux during 2007–2010. The MAR, 3,704,404 km2 in area, accounts for 44.7% lower bathyal habitat (800–3500 m depth) in the North Atlantic and is dominated by fine soft sediment substrate (95% of area) on a series of flat terraces with intervening slopes either side of the ridge axis contributing to habitat heterogeneity. The MAR fauna comprises mainly species known from continental margins with no evidence of greater biodiversity. Primary production and export flux over the MAR were not enhanced compared with a nearby reference station over the Porcupine Abyssal Plain. Biomasses of benthic macrofauna and megafauna were similar to global averages at the same depths totalling an estimated 258.9 kt C over the entire lower bathyal north MAR. A hypothetical flat plain at 3500 m depth in place of the MAR would contain 85.6 kt C, implying an increase of 173.3 kt C attributable to the presence of the Ridge. This is approximately equal to 167 kt C of estimated pelagic biomass displaced by the volume of the MAR. There is no enhancement of biological productivity over the MAR; oceanic bathypelagic species are replaced by benthic fauna otherwise unable to survive in the mid ocean. We propose that globally sea floor elevation has no effect on deep sea biomass; pelagic plus benthic biomass is constant within a given surface productivity regime