Imaging in population science: cardiovascular magnetic resonance in 100,000 participants of UK Biobank - rationale, challenges and approaches

PMCID: PMC3668194SEP was directly funded by the National Institute for Health Research Cardiovascular Biomedical Research Unit at Barts. SN acknowledges support from the Oxford NIHR Biomedical Research Centre and from the Oxford British Heart Foundation Centre of Research Excellence. SP and PL are funded by a BHF Senior Clinical Research fellowship. RC is supported by a BHF Research Chair and acknowledges the support of the Oxford BHF Centre for Research Excellence and the MRC and Wellcome Trust. PMM gratefully acknowledges training fellowships supporting his laboratory from the Wellcome Trust, GlaxoSmithKline and the Medical Research Council

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effects of feeding level and water temperature on growth, nutrient and energy utilization and waste outputs of rainbow trout (

A study was carried out to determine the effect of feeding level and water temperature on growth and feed efficiency, nutrient and energy utilization and waste outputs of rainbow trout. A practical diet was fed to near-satiation to groups of fish reared at 6, 9, 12 and 15 °C. At each temperature, the feed intake of other groups of fish was restricted to about 85 % or 70 % of the amount of feed consumed in the previous week by the fish fed to near-satiation. Total feed intakes over 12 weeks were, on average, 76 % and 65 % of total feed intake of the near-satiety group for R1 and R2, respectively. Reducing the feed allocation resulted in significantly (P < 0.05) lower weight gains compared to feeding to near-satiation regardless of the rearing temperature. Feeding level and water temperature had no significant (P < 0.05) effect on feed efficiency, carcass composition or efficiencies of digestible nitrogen and digestible energy retention. Increasing temperature resulted in an increase in the apparent digestibility of dietary dry matter, nitrogen and energy (P < 0.05). The increase in digestibility of dry matter and nitrogen with increasing temperature resulted in higher estimated total solid and solid nitrogen waste outputs per kg fish produced (P < 0.05) at lower water temperatures. Estimated dissolved nitrogen and phosphorus waste outputs (g/kg fish produced) were not affected by the feeding level or water temperature. A highly significant (P < 0.01) linear relationship was observed between metabolizable energy (ME) intake above basal metabolism and recovered energy. The efficiency of ME utilization for growth (Kpf) was 0.61 and this coefficient was not affected by feed intake or water temperature. Protein and lipid were deposited in a constant ratio (1 kJ protein gain: 1.4 kJ lipid gain) regardless of ME intake or water temperature