Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality

Background &amp; aims The confounding effect of disease on the outcomes of malnutrition using diagnosis-related groups (DRG) has never been studied in a multidisciplinary setting. This study aims to determine the impact of malnutrition on hospitalisation outcomes, controlling for DRG. Methods Subjective Global Assessment was used to assess the nutritional status of 818 patients within 48 hours of admission. Prospective data were collected on cost of hospitalisation, length of stay (LOS), readmission and mortality up to 3 years post-discharged using National Death Register data. Mixed model analysis and conditional logistic regression matching by DRG were carried out to evaluate the association between nutritional status and outcomes, with the results adjusted for gender, age and race. Results Malnourished patients (29%) had longer hospital stays (6.9±7.3 days vs. 4.6±5.6 days, p<0.001) and were more likely to be readmitted within 15 days (adjusted relative risk = 1.9, 95%CI 1.1–3.2, p=0.025). Within a DRG, the mean difference between actual cost of hospitalisation and the average cost for malnourished patients was greater than well-nourished patients (p=0.014). Mortality was higher in malnourished patients at 1 year (34% vs. 4.1 %), 2 years (42.6% vs. 6.7%) and 3 years (48.5% vs. 9.9%); p<0.001 for all. Overall, malnutrition was a significant predictor of mortality (adjusted hazard ratio = 4.4, 95%CI 3.3-6.0, p<0.001). Conclusions Malnutrition was evident in up to one third of inpatients and led to poor hospitalisation outcomes, even after matching for DRG. Strategies to prevent and treat malnutrition in the hospital and post-discharge are needed

Exploring rural secondary school students' attitude toward the Malayan tapir through salient beliefs

Environmental education programmes in Malaysia have been successful in increasing students' knowledge but not so in changing attitudes. To design educational programmes that changes attitudes, we need to understand the underlying determinant of attitude. The purpose of the study was to explore and elicit rural secondary school students' attitudes towards the Malayan tapir through their salient beliefs. Focusing on the cognitive and affective components of the attitude model, eighty-one secondary school students were asked to elucidate what they knew about the Malayan tapir through pictorial stimulation in focus group discussion. Students were observed to be intrigued by the physical characteristics of the Malayan tapir but knew little about its ecological function, natural habitat and threats while displaying positive and negative emotions in reaction to the pictures. Future research implications include the designing of an environmental education programme based on the observations of this study and measuring the effectiveness of the programme in influencing behaviour

Empirical Analysis of Reputation-aware Task Delegation by Humans from a Multi-agent Game (Extended Abstract)

ABSTRACT What are the strategies people adopt when deciding how to delegated tasks to agents when the agents&apos; reputation and productivity information is available? How effective are these strategies under different conditions? These questions are important since they have significant implications to the ongoing research of reputation aware task delegation in multi-agent systems (MASs). In this paper, we conduct an empirical study to address the aforementioned research questions by providing a gamified mechanism for people to report the reputation-aware task delegation strategies they adopt. The findings from this empirical study may help MAS researchers develop multi-agent trust evaluation testbeds with more realistic simulated human behaviours

Irregular meal timing is associated with Helicobacter pylori infection and gastritis

Background Helicobacter pylori (HP) is associated with chronic gastritis and gastric cancer, and more than half of the world’s population is chronically infected. The aim of this retrospective study was to investigate whether an irregular meal pattern is associated with increased risk of gastritis and HP infection. Methods The study involved 323 subjects, divided into three groups: subjects with HP infection and gastritis, with gastritis, and a control group. Subjects were interviewed on eating habits and meal timing. Multivariate logistic regression was used to compare groups. Adjusted odds ratios (OR) were derived controlling for gender, age, stress and probiotic consumption. Results Subjects who deviated from their regular meals by 2 hours or more had a significantly higher incidence of HP infection with gastritis (adjusted OR= 13.3, 95% CI 5.3–33.3, p<0.001) and gastritis (adjusted OR=6.1, 95% CI 2.5–15.0, p<0.001). Subjects who deviated their meals by 2 hours or more, twice or more per week, had an adjusted OR of 6.3 and 3.5 of acquiring HP infection with gastritis (95% CI 2.6–15.2, p<0.001) and gastritis (95% CI 1.5–8.5, p<0.001) respectively. Conclusion Frequent deviation in meal timing over a prolonged period appears associated with increased risk of developing HP infection and gastritis

Irregular Meal Timing Is Associated with Helicobacter pylori

Background Helicobacter pylori (HP) is associated with chronic gastritis and gastric cancer, and more than half of the world’s population is chronically infected. The aim of this retrospective study was to investigate whether an irregular meal pattern is associated with increased risk of gastritis and HP infection. Methods The study involved 323 subjects, divided into three groups: subjects with HP infection and gastritis, with gastritis, and a control group. Subjects were interviewed on eating habits and meal timing. Multivariate logistic regression was used to compare groups. Adjusted odds ratios (OR) were derived controlling for gender, age, stress and probiotic consumption. Results Subjects who deviated from their regular meals by 2 hours or more had a significantly higher incidence of HP infection with gastritis (adjusted OR= 13.3, 95% CI 5.3–33.3, p<0.001) and gastritis (adjusted OR=6.1, 95% CI 2.5–15.0, p<0.001). Subjects who deviated their meals by 2 hours or more, twice or more per week, had an adjusted OR of 6.3 and 3.5 of acquiring HP infection with gastritis (95% CI 2.6–15.2, p<0.001) and gastritis (95% CI 1.5–8.5, p<0.001) respectively. Conclusion Frequent deviation in meal timing over a prolonged period appears associated with increased risk of developing HP infection and gastritis

A multi-agent game for studying human decision-making.

ABSTRACT Understanding how human beings delegate tasks to trustees when presented with reputation information is important for building trust models for human-agent collectives. However, there is a lack of suitable platforms for building large scale datasets on this topic. We describe a demonstration of a multi-agent game for training students in the practice of Agile software engineering. Through interacting with agent competitors in the game, the behavior data related to users&apos; decision-making process under uncertainty and resource constraints are collected in an unobtrusive fashion. These data may provide multi-agent trust researchers with new insight into the human decision-making process, and help them benchmark their proposed models

Therapeutic capsule endoscopy: Opportunities and challenges

ABSTRACT The increasing demand for non-invasive (or less-invasive) monitoring and treatment of medical conditions has attracted both physicians and engineers to work together and investigate new methodologies. Wireless capsule endoscopy is a successful example of such techniques which has become an accepted routine for diagnostic inspection of the gastrointestinal tract. This method offers a non-invasive alternative to traditional endoscopy and provides the opportunity for exploring distal areas of the small intestine which are otherwise not accessible. Despite these advantages, wireless capsule endoscopy is still limited in functionality compared to traditional endoscopy. Wireless capsule endoscopes with advanced functionalities, such as biopsy or drug delivery, are highly desirable. In this article, the current status of wireless capsule endoscopy is reviewed together with some of its possible therapeutic applications as well as the existing challenges

Mutation and Lineage Analysis of DNMT3A in BCR-ABL1-negative Chronic Myeloproliferative Neoplasms

SummaryIn addition to the JAK2 V617F mutation, somatic mutation in DNMT3A has been described in BCL-ABL1-negative myeloproliferative neoplasms (MPNs). We have screened for DNMT3A exon 23 mutations in 130 adult Taiwanese patients with chronic phase myeloproliferative neoplasms. Only one somatic DNMT3A R882H mutation was identified in one JAK2 V617F mutation-positive essential thrombocythemia patient (1/91, 1%). Both mutations were detected in the CD34+-, CD19+-, peripheral blood mononuclear cell- and granulocyte-enriched fractions, but were not detected in the CD3+-enriched fraction by lineage analysis. Our findings suggest that DNMT3A mutation is not prevalent in MPNs, and further study is needed to clarify its role in the molecular pathogenesis of myeloproliferative neoplasms

Association of HLA class I with severe acute respiratory syndrome coronavirus infection

BACKGROUND: The human leukocyte antigen (HLA) system is widely used as a strategy in the search for the etiology of infectious diseases and autoimmune disorders. During the Taiwan epidemic of severe acute respiratory syndrome (SARS), many health care workers were infected. In an effort to establish a screening program for high risk personal, the distribution of HLA class I and II alleles in case and control groups was examined for the presence of an association to a genetic susceptibly or resistance to SARS coronavirus infection. METHODS: HLA-class I and II allele typing by PCR-SSOP was performed on 37 cases of probable SARS, 28 fever patients excluded later as probable SARS, and 101 non-infected health care workers who were exposed or possibly exposed to SARS coronavirus. An additional control set of 190 normal healthy unrelated Taiwanese was also used in the analysis. RESULTS: Woolf and Haldane Odds ratio (OR) and corrected P-value (Pc) obtained from two tails Fisher exact test were used to show susceptibility of HLA class I or class II alleles with coronavirus infection. At first, when analyzing infected SARS patients and high risk health care workers groups, HLA-B*4601 (OR = 2.08, P = 0.04, Pc = n.s.) and HLA-B*5401 (OR = 5.44, P = 0.02, Pc = n.s.) appeared as the most probable elements that may be favoring SARS coronavirus infection. After selecting only a "severe cases" patient group from the infected "probable SARS" patient group and comparing them with the high risk health care workers group, the severity of SARS was shown to be significantly associated with HLA-B*4601 (P = 0.0008 or Pc = 0.0279). CONCLUSIONS: Densely populated regions with genetically related southern Asian populations appear to be more affected by the spreading of SARS infection. Up until recently, no probable SARS patients were reported among Taiwan indigenous peoples who are genetically distinct from the Taiwanese general population, have no HLA-B* 4601 and have high frequency of HLA-B* 1301. While increase of HLA-B* 4601 allele frequency was observed in the "Probable SARS infected" patient group, a further significant increase of the allele was seen in the "Severe cases" patient group. These results appeared to indicate association of HLA-B* 4601 with the severity of SARS infection in Asian populations. Independent studies are needed to test these results