Reduced Cortisol Metabolism during Critical Illness

Critical illness is often accompanied by hypercortisolemia, which has been attributed to stress-induced activation of the hypothalamic-pituitary-adrenal axis. However, low corticotropin levels have also been reported in critically ill patients, which may be due to reduced cortisol metabolism.status: publishe

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Take a bite! The effect of bitten food in pictures on product attitudes, purchase intentions, and willingness to pay

Food pictures in advertisements, on packages, and on social media often display food with a bite in it. We investigated the effect of pictures of food with a bite (vs. no bite) on product attitudes, purchase intentions, and willingness to pay. In two online experimental studies we tested this effect for both pictures without context, as well as pictures in an advertisement. We also investigated two theories that could lead to opposite effects: consumer contamination and embodied mental simulation. We found that a picture of food with a bite (vs. no bite) resulted in lower purchase intentions, and that this effect was mediated by disgust (i.e., consumer contamination). Furthermore, we found an interaction effect of picture type (i.e., bite vs. no bite) and context (i.e., no context vs. advertisement) on purchase intentions: the effect of picture type on purchase intentions was attenuated when the picture appeared in an advertisement (vs. when the picture is shown without context). We found similar effects on product attitudes and willingness to pay. Lastly, a picture of food with a bite (vs. no bite) had no effect on embodied mental simulation. Field practitioners are advised to take caution when using pictures of bitten food as this may lead to unfavorable consumer responses because of a feeling if disgust

What a mess! The effect of messiness in food pictures on unhealthy food choices

Consumers are more likely to choose unhealthy food when pictures present the food in a messy (vs. neat) way. The 'messy food picture trend' displays food in an unbalanced, unlevel, random, unsorted and untidy way. Three studies (N = 1796) involving both snacks and meals show that exposure to a messy (vs. neat) food presentation in pictures renders consumers more likely to choose unhealthy food. Three possible mechanisms underlying this effect were tested: processing style, self-control, and product vividness. Evidence was found for the latter. The 'messy food effect' occurs because a messy (vs. neat) food presentation increases product vividness, which elevates consumers' need for instant gratification. Furthermore, the 'messy food effect' is moderated by consumers' orderliness in eating contexts. For consumers who usually eat in a highly orderly way, messy (vs. neat) food pictures do not affect product vividness and the number of unhealthy food choices

The effect of perspectives in food pictures on unhealthy food choices

Consumers choose less unhealthy food when seeing pictures of food shot in a top perspective vs. a diner's eye perspective. These two commonly used perspectives in food pictures respectively show the food vertically downwards, or mimic the viewing point of a person sitting at a table, looking at the food in front of them on the table. Although both perspectives are frequently used in food pictures, consumers are more used to seeing their food from a diner's eye perspective. We show that lower familiarity with seeing food in top perspective (vs. diner's eye perspective) decreases product vividness and subsequently lowers consumers' need for instant gratification. Hence, less unhealthy food is chosen