Prolonged progressive hypermetabolism during COVID-19 hospitalization undetected by common predictive energy equations

Background & Aims: Indirect calorimetry (IC) is the gold-standard for determining measured resting energy expenditure (mREE) in critical illness. When IC is not available, predicted resting energy expenditure (pREE) equations are commonly utilized, which often inaccurately predict metabolic demands leading to over- or under-feeding. This study aims to longitudinally assess mREE via IC in critically ill patients with SARS-CoV-2 (COVID-19) infection throughout the entirety of, often prolonged, intensive care unit (ICU) stays and compare mREE to commonly utilized pREE equations. / Methods: This single-center prospective cohort study of 38 mechanically ventilated COVID-19 patients from April 1, 2020 to February 1, 2021. The Q-NRG® Metabolic Monitor was used to obtain IC data. The Harris-Benedict (HB), Mifflin St-Jeor (MSJ), Penn State University (PSU), and weight-based equations from the American Society of Parenteral and Enteral Nutrition – Society of Critical Care Medicine (ASPEN-SCCM) Clinical Guidelines were utilized to assess the accuracy of common pREE equations and their ability to predict hypo/hypermetabolism in COVID-19 ICU patients. / Results: The IC measures collected revealed a relatively normometabolic or minimally hypermetabolic mREE at 21.3 kcal/kg/d or 110% of predicted by the HB equation over the first week of mechanical ventilation (MV). This progressed to significant and uniquely prolonged hypermetabolism over successive weeks to 28.1 kcal/kg/d or 143% of HB predicted by MV week 3, with hypermetabolism persisting to MV week 7. Obese individuals displayed a more truncated response with significantly lower mREE versus non-obese patients in MV week 1 (19.5±1.0 kcal/kg/d vs 25.1±1.8 kcal/kg/d, respectively; p < 0.01), with little change in weeks 2-3 (19.5±1.5 kcal/kg/d vs 28.0±2.0 kcal/kg/d; p < 0.01). Both ASPEN-SCCM upper range and PSU pREE equations provided close approximations of mREE yet, like all pREE equations, occasionally over- and under-predicted energy needs and typically did not predict late hypermetabolism. / Conclusions: Study results show a truly unique metabolic response in COVID-19 ICU patients, characterized by significant and prolonged, progressive hypermetabolism peaking at 3 weeks’ post-intubation, persisting for up to 7 weeks in ICU. This pattern was more clearly demonstrated in non-obese versus obese patients. This response is unique and distinct from any previously described model of ICU stress response in its prolonged hypermetabolic nature. This data reaffirms the need for routine, longitudinal IC measures to provide accurate energy targets in COVID-19 ICU patients. The PSU and ASPEN-SCCM equations appear to yield the most reasonable estimation to IC-derived mREE in COVID-19 ICU patients, yet still often over-/under-predict energy needs. These findings provide a practical guide for caloric prescription in COVID-19 ICU patients in the absence of IC

Bridge distress caused by approach embankment settlement

Surtees Bridge, which carries the A66(T) over the River Tees near Thornaby-on-Tees in the UK, has been showing signs of distress that predate its opening in 1981. Subsequent investigations have shown that the bridge distress is related to unexpectedly large settlement of the eastern approach embankment. Recent ground investigations prompted by a proposed widening of the river crossing have produced many new data on the alluvial deposits underlying the site, and explain why embankment settlement was so much larger than originally anticipated. Comparison of the geotechnical parameters obtained from the original and more recent ground investigations suggests that the original investigation significantly underestimated the thickness of an alluvial clay layer underlying the site, and that its coefficient of consolidation was overestimated. Settlement analyses using geotechnical data from the original ground investigations predict moderate embankment settlements occurring principally during construction. Settlement analyses based on all the available data predict far larger embankment settlements occurring over extended time periods. The latter analyses predict an embankment settlement similar to that observed and of sufficient magnitude to cause the observed lateral displacement of the bridge due to lateral loading of its piled foundation

Current Status of Nutrition Training in Graduate Medical Education From a Survey of Residency Program Directors

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142009/1/jpen0095.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142009/2/jpen0095-sup-0001.pd

Hypertension and happiness across nations

In surveys of well-being, countries such as Denmark and the Netherlands emerge as particularly happy while nations like Germany and Italy report lower levels of happiness. But are these kinds of findings credible? This paper provides some evidence that the answer is yes. Using data on 16 countries, it shows that happier nations report systematically lower levels of hypertension. As well as potentially validating the differences in measured happiness across nations, this suggests that blood-pressure readings might be valuable as part of a national well-being index. A new ranking of European nations’ GHQ-N6 mental health scores is also given

Head Motion Analysis and Synthesis over Different Tasks

Abstract. It is known that subjects vary in their head movements. This paper presents an analysis of this variety over different tasks and speakers and their impact on head motion synthesis. Measured head and articulatory movements acquired by an ElectroMagnetic Articulograph (EMA) synchronously recorded with audio was used. Data set of speech of 12 people recorded on different tasks confirms that the head motion variate over tasks and speakers. Experimental results confirmed that the proposed models were capable of learning and synthesising task-dependent head motions from speech. Subjective evaluation of synthesised head motion using task models shows that trained models on the matched task is better than mismatched one and free speech data provide models that predict preferred motion by the participants compared to read speech data

The association between failed quit attempts and increased levels of psychological distress in smokers in a large New Zealand cohort

<p>Abstract</p> <p>Background</p> <p>Although the association between smoking status and poorer mental health has been well documented, the association between quit status and psychological distress is less clear. The aim of the present study is to investigate the association of smoking status and quit status with psychological distress.</p> <p>Methods</p> <p>Data for this study is from a single year of the Survey of Families, Income and Employment (SoFIE) conducted in New Zealand (2004/05) (n = 18,525 respondents). Smoking status and quit status were treated as exposure variables, and psychological distress (Kessler-10) was treated as the outcome variable. Logistic regression analyses were performed to determine the association of smoking with psychological distress in the whole adult population and quit status with psychological distress in the ex- and current-smoking population.</p> <p>Results</p> <p>Current smokers had higher rates of high and very high psychological distress compared to never smokers (adjusted odds ratio (aOR) = 1.45; 95% CI: 1.24-1.69). Unsuccessful quitters had much higher levels of high to very high levels of psychological distress (16%) than any other group. Moreover, compared to long-term ex-smokers, unsuccessful quitters had a much higher odds of high to very high levels of psychological distress (aOR = 1.73; 95% CI: 1.36-2.21).</p> <p>Conclusion</p> <p>These findings suggest that the significant association between smoking and psychological distress might be partly explained by increased levels of psychological distress among current smokers who made a quit attempt in the last year. This issue needs further study as it has implications for optimising the design of quitting support.</p

Smoking and health-related quality of life in English general population: Implications for economic evaluations

Copyright @ 2012 Vogl et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been made available through the Brunel Open Access Publishing Fund.Background: Little is known as to how health-related quality of life (HRQoL) when measured by generic instruments such as EQ-5D differ across smokers, ex-smokers and never-smokers in the general population; whether the overall pattern of this difference remain consistent in each domain of HRQoL; and what implications this variation, if any, would have for economic evaluations of tobacco control interventions. Methods: Using the 2006 round of Health Survey for England data (n = 13,241), this paper aims to examine the impact of smoking status on health-related quality of life in English population. Depending upon the nature of the EQ-5D data (i.e. tariff or domains), linear or logistic regression models were fitted to control for biology, clinical conditions, socio-economic background and lifestyle factors that an individual may have regardless of their smoking status. Age- and gender-specific predicted values according to smoking status are offered as the potential 'utility' values to be used in future economic evaluation models. Results: The observed difference of 0.1100 in EQ-5D scores between never-smokers (0.8839) and heavy-smokers (0.7739) reduced to 0.0516 after adjusting for biological, clinical, lifestyle and socioeconomic conditions. Heavy-smokers, when compared with never-smokers, were significantly more likely to report some/severe problems in all five domains - mobility (67%), self-care (70%), usual activity (42%), pain/discomfort (46%) and anxiety/depression (86%) -. 'Utility' values by age and gender for each category of smoking are provided to be used in the future economic evaluations. Conclusion: Smoking is significantly and negatively associated with health-related quality of life in English general population and the magnitude of this association is determined by the number of cigarettes smoked. The varying degree of this association, captured through instruments such as EQ-5D, may need to be fed into the design of future economic evaluations where the intervention being evaluated affects (e.g. tobacco control) or is affected (e.g. treatment for lung cancer) by individual's (or patients') smoking status