Dietary Patterns and Cognitive Health in Older Adults: Findings from the Sydney Memory and Ageing Study.

OBJECTIVES: Systematic reviews report dietary patterns may be associated with cognitive health in older adults. However, inconsistent findings have been reported and relevant research lacks large scale studies. This study aims to examine the associations of dietary patterns and cognitive function among older adults in an Australian ageing cohort. DESIGN: A population-based, cross-sectional analysis of the baseline phase of the Sydney Memory and Ageing Study, a well-characterised Australian ageing study. SETTING: The Sydney Memory and Ageing Study was initiated in 2005 to examine the clinical characteristics and prevalence of mild cognitive impairment (MCI). PARTICIPANTS: Non-demented community-dwelling individuals from English-speaking background (N = 819) aged 70-90 recruited from two areas of Sydney, following a random approach to 8914 individuals on the electoral roll in the Sydney Memory and Ageing study. MEASUREMENTS: The Cancer Council of Victoria Food Frequency Questionnaire was used to assess dietary intake. Scores for Mediterranean diet, Dietary Approaches to Stop Hypertension (DASH) diet and the Dietary Guidelines Index (DGI 2013) were generated. Two patterns - a Prudent healthy and a Western dietary pattern - were derived using principal components analysis (PCA). Neuropsychological tests were used to assess global cognition and six cognitive domains. Multivariate linear modelling assessed the relationship between dietary patterns and cognitive domain scores. RESULTS: Mediterranean diet and DASH diet were both positively linked to visuospatial cognition (P=0.002 and P=0.001 respectively). Higher intake of legumes and nuts was related to better performance in global cognition (ß=0.117; 95% CI:0.052, 0.181; P<0.001) and language and visuospatial cognitive domains. The Prudent healthy diet was associated with better global cognition (ß=0.307; 95% CI: 0.053, 0.562; P=0.019) in women and a Western diet was related to poorer global function (ß=-0.242; 95% CI: -0.451,-0.034; P=0.023) and executive function (ß=-0.325; 95% CI: -0.552,-0.099; P=0.005) in men. CONCLUSION: In this analysis, higher adherence to the Mediterranean diet, DASH diet, Prudent healthy diet and greater consumption of legumes and nuts were associated with better cognition among older adults.

A pilot denture service collaboration between Den-Tech denture charity and Crisis at Christmas Dental Service (CCDS): A Plan-Do-Study-Act analysis.

Introduction The Crisis at Christmas Dental Service (CCDS) provides dental treatment for homeless and vulnerably housed people each year during the Christmas period. In 2017, Den-Tech piloted a same-day field-laboratory denture service alongside CCDS to provide new dentures, additions and repairs for people experiencing social exclusion who have limited access to dental care.Objectives To evaluate the service in terms of: (i) treatment need for denture service; (ii) patient-reported feedback; (iii) clinician-reported feedback; and (iv) learning outcomes from the pilot denture service.Methods Clinicians recorded their dental activity on a standard pro forma and records of the dentures were maintained by the Den-Tech volunteer laboratory technicians. Patient feedback was collected on standardised feedback forms at the dental reception and volunteer feedback was collected via an online survey. The team undertook a quality improvement evaluation using the Plan-Do-Study-Act methodology.Results During the seven-day treatment period in 2017, 24 dentures were produced by the Den-Tech technicians, and in 2018, 31 dentures were created for people experiencing homelessness. In 2017, feedback was collected from 353 patients who attended the service: 99.4% were satisfied with their treatment and 98.3% would have recommended the service to others. Similarly, high levels of positive feedback were received in 2018. Of the dental volunteers who responded, 97.8% of volunteers felt that the denture service benefitted the patients.Conclusions The Den-Tech denture service was well-received by patients and volunteers alike. For the first time at Crisis at Christmas, patients were able to have dental extractions and immediate replacement of these teeth without compromising their dignity and overall appearance.Learning outcomes A quality improvement project utilising real-time volunteer and patient feedback can be a useful tool in reflecting upon the challenges and successes of a service as well as supporting its continual development.

Effect of delay between nuclear medicine scanning and sentinel node biopsy on outcome in patients with cutaneous melanoma.

BACKGROUND: Sentinel lymph node biopsy (SLNB) is an important staging tool for the management of melanoma. A multicentre study was done to validate previous findings that the timing of lymphoscintigraphy influences the accuracy of SLNB and patient outcomes, particularly survival. METHODS: Data were reviewed on patients undergoing SLNB for melanoma at three centres in the UK and Sweden, examining the effect of timing of SLNB after nuclear medicine scanning. Kaplan-Meier survival analysis was used to assess overall (OS), disease-specific (DSS) and progression-free (PFS) survival, stratified by timing of lymphoscintigraphy. Independent risk factors for survival were identified by Cox multivariable regression analysis. RESULTS: A total of 2270 patients were identified. Median follow-up was 56 months. Univariable analysis showed a 4·2 per cent absolute and 35·5 per cent relative benefit in DSS (hazard ratio 1·36, 95 per cent c.i. 1·05 to 1·74; P = 0·018) for 863 patients whose SLNB was performed up to 12 h after lymphoscintigraphy compared with 1407 patients who had surgery after more than 12 h. There were similar OS and PFS benefits (P = 0·036 and P = 0·022 respectively). Multivariable analysis identified timing of lymphoscintigraphy as an independent predictor of OS (P = 0·017) and DSS (P = 0·030). There was an excess of nodal recurrences as first site of recurrence in the group with delayed surgery (4·5 versus 2·5 per cent; P = 0·008). CONCLUSION: Delaying SLNB beyond 12 h after lymphoscintigraphy with 99 Tc-labelled nanocolloid has a significant negative survival impact in patients with melanoma.

ANTECEDENTES: La biopsia de ganglio centinela (sentinel lymph node biopsy, SLNB) es una técnica importante para la estadificación y tratamiento del melanoma. Se realizó un estudio multicéntrico para validar hallazgos previos según los cuales el momento de la linfogammagrafía (lymphoscintigraphy, LS) influye en la precisión de la SLNB y en los resultados de los pacientes, especialmente en la supervivencia. MÉTODOS: Se revisaron los datos de los pacientes a los que se realizó una SLNB por melanoma en 3 centros en el Reino Unido y Suecia, con especial atención al efecto del período entre la inyección el material radioactivo y la SLNB. Se realizó un análisis de supervivencia mediante el método de Kaplan-Meier para la supervivencia específica de la enfermedad (disease-specific survival, DSS), supervivencia global (overall survival, OS) y supervivencia libre de progresión (progression-free survival, PFS), todas ellas estratificadas por el momento de la LS. Los factores de riesgo independientes para la supervivencia se determinaron mediante un análisis de regresión multivariable de Cox. RESULTADOS: Se incluyeron 2.270 pacientes. La mediana de seguimiento fue de 49 meses. El análisis univariado mostró un beneficio absoluto del 4,2% y relativo del 35,5% (cociente de riesgos instantáneos, hazard ratio, HR: 1,36 (i.c. del 95% 1,05-1,74, P = 0.02)) en la DDS para los pacientes a los que la SLNB se realizó < 12 horas después de la LS (n = 863) en comparación con aquellos realizados > 12 horas (n = 1407). Se detectaron beneficios similares para la OS y la PFS (P = 0,04 y P = 0,02, respectivamente). El análisis multivariable identificó el tiempo entre la LS y la SLNB como un factor independiente de OS (P = 0,017) y DSS (P = 0,03). Hubo un aumento en las recidivas ganglionares como primer sitio de recidiva en el grupo de > 12 horas (2,5% versus 4,5%; P = 0,008). CONCLUSIÓN: Estos datos validan nuestra investigación previa y tienen implicaciones significativas para las unidades de melanoma, en el sentido de que retrasar la SLNB más allá de las 12 horas después de realizar la LS con nanocoloides marcados con Tc99 tiene un impacto negativo significativo en la supervivencia de los pacientes y debe evitarse. Se presenta la hipótesis de que la causa subyacente es la migración temporal del trazador que determina una SLNB incorrecta. .

The relationship between process use and stage of change for sugary drinks.

BACKGROUND: Decreasing sugar-sweetened beverage consumption may reduce obesity and obesity-related diseases. To better understand what processes could facilitate a reduction in sugary beverage intake, we examined the relationship between stage-of-change and use of 10 processes of change. Secondarily, reliability of the measure was assessed. METHODS: A cross-sectional study was conducted, using a newly developed stage-of-change and process of change questionnaire. Participants (n = 105; male, n = 28) were aged between 18 and 60 years. A one-way analysis of variance, with Tukey's and Benjamini-Hochberg post hoc tests, was used to compare process use by stages. Paired t-tests were used to compare total cognitive and total behavioural process use within each stage. Cronbach's α coefficient and mean inter-item correlation was used to assess internal consistency. Reliability of repeated items was examined using kappa. RESULTS: Cognitive and behavioural processes were used more in the contemplation/preparation and maintenance stages than in precontemplation (all P < 0.05). Compared to precontemplation, process use was significantly higher in contemplation/preparation for five individual processes, action for four processes and maintenance for five processes. The use of dramatic relief and self liberation was lower in maintenance than contemplation/preparation. Across the stages, the use of eight of the 10 processes differed. The use of consciousness raising, self re-evaluation and self liberation differed between stages more frequently than other processes. CONCLUSIONS: The use of many processes differed by stage and could be incorporated into programmes aiming to assist adults in reducing their consumption of sugary drinks.

What is a regional trainee representative? A personal perspective of a pilot role within the East Midlands.

Dental trainees have an important role to play in quality assuring training programmes. Local education and training boards (LETBs) actively encourage trainee engagement through structured feedback, which acts as a valuable source of critical appraisal. This is designed to support the structure of training programmes and influences its quality and content. In 2014, East Midlands LETB appointed a regional trainee representative to collate, present and promote dental foundation and core trainee issues to the Dental School Board, as well as highlight their accomplishments and achievements. The pilot brief given was to evolve the post to better support trainees and quality manage the various feedback pathways. This allowed for further research into the existing trainee representative posts across the East Midlands, and highlighted the specific and unique benefits of having regional trainee representation to be the overarching voice on the LETB. This article sets out the framework of responsibilities of a regional trainee representative, contrasts it with established representative posts (regionally and nationally), and advocates why dental schools should appoint to these positions to promote the voices of their trainees. It will also explain the advantages of being a representative, as well as highlight some of the challenges, in the hope that it encourages the next generation to consider applying for these roles.

Acral Lentiginous Melanoma - misdiagnosis, referral delay and 5 years specific survival according to site.

OBJECTIVES: Acral lentiginous melanoma (ALM) is a defined histopathological entity with peculiar clinical-pathological features and is the most common subtype of malignant melanoma in acral locations. The 5-year survival rate is lower than that for all cutaneous malignant melanoma overall (80.3% versus 91.3%). Controversy exists in the literature as to whether this worse prognosis is attributable to a more aggressive biological nature or to difficult-to-see sites and consequent advanced stage at the time of diagnosis. The main purpose of the study was to explore any prognostic difference according to upper limb or lower limb localizations, based on the hypothesis that upper limb localizations might receive attention sooner than lower limb localizations. PATIENTS AND METHODS: A cohort longitudinal study was performed through a retrospective review of all patients consecutively referred to our Unit with histological confirmation of ALM. Data were collected from a 10 year period between 1996 and 2006 to allow determination of 5 year survival statistics. RESULTS: Out of 87 patients included in the study, 32 were men (37%) and 55 were women 63%. The average number of months it took for patients to present was 62 months with a mode of 12 months. Overall 5 year survival was 80% and a multivariate analysis showed that the most reliable prognostic indicators are the Breslow's thickness and the margins of complete excision. When controlling the survival rates for Breslow thickness, the values were similar to the reported rates indicated in the recent literature for cutaneous malignant melanoma. CONCLUSIONS: The higher aggressiveness of ALM was noticed to be attributable to a later stage and more advanced thickness at diagnosis. No significant difference was found between upper and lower limb localization in terms of prognosis.

Are we ready to "think ahead"? Acceptability study using an innovative end of life planning tool.

This is a cross sectional study in 5 GP Training Practices, sample size 100 clinically stable patients, attending for routine care. Purpose of the study was explained and informed written consent was sought. Participants were provided with 'Think Ahead,' an innovative end of life planning tool, devised by The Forum on The End of Life, based on best international practice, presented in a questionnaire format, detailing main decision centres relevant in end of life planning. Participants completed telephone surveys at 1 and 3 weeks, ascertaining their experience with 'Think Ahead;' 92/100 completed both surveys. Results indicate high levels of acceptability and positive experience for most participants. A majority (63%) indicated 'no difficulty' in completing 'Think Ahead;' 74% indicated reported they did not find completing the folder to cause upset; 87% indicated they felt the folder should be more widely available, and 68% indicated they felt 'Think Ahead' would be of general interest. The study was effective in encouraging discussion on end of life issues with family (83%) with 49% indicating they had done so in detail, and 34% indicating having 'done so somewhat,' having read 'Think Ahead; 27% indicated aspects of it were upsetting. Results will be used to inform further development of the tool. General Practice consulting is a suitable context in which to systematically present 'Think Ahead.'

Immune system phenotyping of radiation and radiation combined injury in outbred mice.

The complexity of a radionuclear event would be immense due to varying levels of radiation exposures and injuries caused by blast-associated trauma. With this scenario in mind, we developed a mouse model to mimic as closely as possible the potential consequences of radiation injury and radiation combined injury (RCI) on survival, immune system phenotype, and immune function. Using a mouse burn injury model and a (137)CsCl source irradiator to induce injuries, we report that the immunological response to radiation combined injury differs significantly from radiation or burn injury alone. Mice that underwent radiation combined injury showed lower injury survival and cecal ligation and puncture (CLP) induced polymicrobial sepsis survival rates than mice with single injuries. As anticipated, radiation exposure caused dose-dependent losses of immune cell subsets. We found B and T cells to be more radiation sensitive, while macrophages, dendritic cells and NK cells were relatively more resistant. However, radiation and radiation combined injury did induce significant increases in the percentages of CD4(+) regulatory T cells (Tregs) and a subset of macrophages that express cell-surface GR-1 (GR-1(+) macrophages). Immune system phenotyping analysis indicated that spleen cells from radiation combined injury mice produced higher levels of proinflammatory cytokines than cells from mice with radiation or burn injury alone, especially at lower dose radiation exposure levels. Interestingly, this enhanced proinflammatory phenotype induced by radiation combined injury persisted for at least 28 days after injury. In total, our data provide baseline information on differences in immune phenotype and function between radiation injury and radiation combined injury in mice. The establishment of this animal model will aid in future testing for therapeutic strategies to mitigate the immune and pathophysiological consequences of radionuclear events.

B vitamin status, dietary intake and length of stay in a sample of elderly rehabilitation patients.

OBJECTIVES: To investigate the relationships between previous diet, biomarkers of selected B vitamins, nutritional status and length of stay. DESIGN: Cross sectional study. SETTING: Geriatric rehabilitation patients, Sydney, Australia. PARTICIPANTS: Fifty two consenting patients with normal serum creatinine levels and no dementia. MEASUREMENTS: Serum vitamin B12, plasma vitamin B6, serum and erythrocyte folate, homocysteine and methylmalonic acid (MMA) concentrations; dietary intake using a validated semi-quantitative food frequency questionnaire and nutritional assessment using the Mini Nutritional Assessment (MNA). Length of stay data were collected from medical records after discharge. RESULTS: The age was 80 ± 8 year (mean ± SD), BMI 26.4 ± 6.8 kg/m2 and MNA score 22 ± 3 indicating some risk of malnutrition. Deficiencies of vitamins B6, B12 and folate were found in 30, 22 and 5 subjects respectively. Length of stay was positively correlated with age and MMA (Spearman's correlation 0.4, p<0.01 and 0.28, p<0.05 respectively) and negatively correlated with albumin, vitamin B6 and MNA score (Spearman's correlation -0.35, -0.33 and -0.29, p<0.05). After adjustment for age and sex, ln vitamin B6 and ln MMA concentrations were significant in predicting ln LOS (p=0.006 and p=0.014 respectively). CONCLUSION: The study indicates a high risk of vitamin B deficiencies in the elderly and suggests that deficiencies of vitamins B6 and B12 are associated with length of stay. This is concerning as B vitamin status is rarely fully assessed.

Is email a reliable means of contacting authors of previously published papers? A study of the Emergency Medicine Journal for 2001.

OBJECTIVES: To determine whether it is possible to contact authors of previously published papers via email. METHODS: A cross sectional study of the Emergency Medicine Journal for 2001. RESULTS: 118 articles were included in the study. The response rate from those with valid email addresses was 73%. There was no statistical difference between the type of email address used and the address being invalid (p=0.392) or between the type of article and the likelihood of a reply (p=0.197). More responses were obtained from work addresses when compared with Hotmail addresses (86% v 57%, p=0.02). CONCLUSIONS: Email is a valid means of contacting authors of previously published articles, particularly within the emergency medicine specialty. A work based email address may be a more valid means of contact than a Hotmail address.

Long-term structural remodeling in Aplysia sensory neurons requires de novo protein synthesis during a critical time period.

Long-term sensitization training induces persistent changes in both electrophysiological properties and specific structural features of sensory neurons in Aplysia californica. Previously, we found that transient elevation of intracellular cAMP could also modify these features in sensory neurons located in the pleural ganglion. In the present study we examined the role of protein synthesis in structural remodeling induced by cAMP. When applied during the intracellular injection of cAMP, anisomycin blocked increases in both the number of varicosities and the number of branch points in single sensory neurons. Exposure to anisomycin during different time periods, from as early as 12 hr prior to cAMP injection to periods as late as 15 hr after, indicated that the requirement for protein synthesis starts at the time of cAMP injection and extends for at least seven hours afterwards. Because it is metabolized rapidly, cAMP probably triggers a cascade of protein synthesis whose products continue to be synthesized for several hours after cAMP levels have returned to baseline. Thus, the present results suggest that the induction of long-term structural changes in sensory neurons has an extended but finite requirement for protein synthesis.