Computerized Cognitive Training in Mild Cognitive Impairment: Findings in African Americans and Caucasians.

BACKGROUND: African Americans with MCI may be at increased risk for dementia compared to Caucasians. The effect of race on the efficacy of cognitive training in MCI is unclear. METHODS: We used data from a two-site, 78-week randomized trial of MCI comparing intensive, home-based, computerized training with Web-based cognitive games or Web-based crossword puzzles to examine the effect of race on outcomes. The study outcomes were changes from baseline in cognitive and functional scales as well as MRI-measured changes in hippocampal volume and cortical thickness. Analyses used linear models adjusted for baseline scores. This was an exploratory study. RESULTS: A total of 105 subjects were included comprising 81 whites (77.1%) and 24 African Americans (22.8%). The effect of race on the change from baseline in ADAS-Cog-11 was not significant. The effect of race on change from baseline to week 78 in the Functional Activities Questionnaire (FAQ) was significant with African American participants' FAQ scores showing greater improvements at weeks 52 and 78 (P = 0.009, P = 0.0002, respectively) than white subjects. Within the CCT cohort, FAQ scores for African American participants showed greater improvement between baseline and week 78, compared to white participants randomized to CCT (P = 0.006). There was no effect of race on the UPSA. There was no effect of race on hippocampal or cortical thickness outcomes. CONCLUSIONS: Our preliminary findings suggest that web-based cognitive training programs may benefit African Americans with MCI at least as much as Caucasians, and highlight the need to further study underrepresented minorities in AD prevention trials. (Supported by the National Institutes of Health, National Institute on Aging; ClinicalTrials.gov number, NCT03205709.).

Induction of Larval Settlement in the Reef Coral Porites astreoides by a Cultivated Marine Roseobacter Strain.

Successful larval settlement and recruitment by corals is critical for the survival of coral reef ecosystems. Several closely related strains of γ-proteobacteria have been identified as cues for coral larval settlement, but the inductive properties of other bacterial taxa naturally occurring in reef ecosystems have not yet been explored. In this study, we assayed bacterial strains representing taxonomic groups consistently detected in corals for their ability to influence larval settlement in the coral Porites astreoides. We identified one α-proteobacterial strain, Roseivivax sp. 46E8, which significantly increased larval settlement in P. astreoides. Logarithmic growth phase (log phase) cell cultures of Roseivivax sp. 46E8 and filtrates (0.22µm) from log phase Roseivivax sp. 46E8 cultures significantly increased settlement, suggesting that an extracellular settlement factor is produced during active growth phase. Filtrates from log phase cultures of two other bacterial isolates, Marinobacter sp. 46E3, and Cytophaga sp. 46B6, also significantly increased settlement, but the cell cultures themselves did not. Monospecific biofilms of the three strains did not result in significant increases in larval settlement. Organic and aqueous/methanol extracts of Roseivivax sp. 46E8 cultures did not affect larval settlement. Examination of filtrates from cell cultures showed that Roseivivax sp. 46E8 spontaneously generated virus-like particles in log and stationary phase growth. Though the mechanism of settlement enhancement by Roseivivax sp. 46E8 is not yet elucidated, our findings point to a new aspect of coral-Roseobacter interactions that should be further investigated, especially in naturally occurring, complex microbial biofilms on reef surfaces.

A randomized, prospective pilot study of patient expectancy and antidepressant outcome.

BACKGROUND: This study is a randomized, prospective, investigation of the relationships between clinical trial design, patient expectancy and the outcome of treatment with antidepressant medication. Method Adult out-patients with major depressive disorder (MDD) were randomized to either placebo-controlled (PC, 50% probability of receiving active medication) or comparator (COMP, 100% probability of receiving active medication) administration of antidepressant medication. Independent-samples t tests and analysis of covariance (ANCOVA) were used to determine whether the probability of receiving active medication influenced patient expectancy and to compare medication response in the PC v. COMP conditions. We also tested the correlations between baseline expectancy score and final improvement in depressive symptoms across study groups. RESULTS: Subjects randomized to the COMP condition reported greater expectancy of improvement compared to subjects in the PC condition (t = 2.60, df = 27, p = 0.015). There were no statistically significant differences in the analyses comparing antidepressant outcomes between subjects receiving medication in the COMP condition and those receiving medication in the PC condition. Higher baseline expectancy of improvement was correlated with lower final depression severity scores (r = 0.53, p = 0.021) and greater improvement in depressive symptoms over the course of the study (r = 0.44, p = 0.058). CONCLUSIONS: The methods described represent a promising way of subjecting patient expectancy to scientific study. Expectancy of improvement is affected by the probability of receiving active antidepressant medication and seems to influence antidepressant response.

Salivary biomarkers associated with myocardial necrosis: results from an alcohol septal ablation model.

OBJECTIVE: To determine if salivary biomarkers demonstrate utility for identifying aspects of myocardial necrosis. METHODS: Twenty-one patients undergoing alcohol septal ablation (ASA) for treatment of hypertrophic cardiomyopathy provided serum and unstimulated whole saliva at baseline and incremental time points post-ASA. Samples were analyzed for seven biomarkers related to myocardial damage, inflammation, and tissue remodeling using immunosorbent assays. Levels were compared with baseline and levels observed in 97 healthy controls. RESULTS: Biomarkers of myocardial damage and inflammation (ie, troponin I, creatine kinase-MB, myoglobin, C-reactive protein) rose in serum 2- to 812-fold after ASA (P < .01). Significant elevations of 2.0- to 3.5-fold were observed with C-reactive protein and troponin I in saliva (P < .02). Significant correlations between levels in serum and saliva were observed for C-reactive protein, matrix metalloproteinase-9, and myeloperoxidase (P < .001). CONCLUSIONS: Select salivary biomarkers reflect changes that occur during, and subsequent to, myocardial necrosis caused by ASA.

Oral fluids that detect cardiovascular disease biomarkers.

OBJECTIVE: The aim of this study was to determine the utility of oral fluids for assessment of coronary and cardiovascular (CV) health. STUDY DESIGN: Twenty-nine patients with preexisting CV disease underwent an invasive cardiac procedure (alcohol septal ablation or percutaneous coronary intervention) and provided unstimulated whole saliva (UWS), sublingual swabs (LS), gingival swabs (GS) and serum at 0, 8, 16, 24, and 48 hours. Concentrations of 13 relevant biomarkers were determined and correlated with levels in serum and the oral fluids. RESULTS: Concentrations of the majority of biomarkers were higher in UWS than in LS and GS. Coronary and CV disease biomarkers in UWS correlated better with serum than with LS and GS based on group status and measures of time effect. Seven biomarkers demonstrated time effect changes consistent with serum biomarkers, including C-reactive protein and troponin I. CONCLUSIONS: Changes in serum biomarker profiles are reflected in oral fluids suggesting that oral fluid biomarkers could aid in the assessment of cardiac ischemia/necrosis.

Antidepressant study design affects patient expectancy: a pilot study.

BACKGROUND: Response to antidepressant medication is higher in comparator versus placebo-controlled randomized controlled trials (RCTs). Patient expectancy is an important influence on clinical outcome in the treatment of depression and may explain this finding. The results are reported from a pilot RCT studying expectancy and depression outcome in placebo-controlled versus comparator treatment conditions.MethodOut-patients aged 18-65 years with major depressive disorder (MDD) were enrolled in this 8-week RCT. Subjects were randomized to placebo-controlled (escitalopram or placebo) or comparator (escitalopram or citalopram) administration of antidepressant medication. Subjects reported their expected likelihood and magnitude of depression improvement before and after randomization using questions from the Credibility and Expectancy Scale (CES). A regressed change model of post-randomization expectancy of improvement was fit to the data to determine whether subjects in the comparator group reported greater expectancies of improvement than subjects in the placebo-controlled group. RESULTS: Twenty subjects with mean age 56.5+/-11.7 years, a baseline Hamilton Depression Rating Scale (HAMD) score of 24.2+/-5.3, baseline Beck Depression Inventory (BDI) score of 24.9+/-6.4 and baseline Clinical Global Impressions (CGI) - Severity score of 4.0+/-0.3 were enrolled in the study. Adjusting for other factors, the effect of group assignment on expected magnitude of improvement was significant and large (effect size 1.5). No group differences in expected likelihood of improvement were found. CONCLUSIONS: Randomization to comparator versus placebo-controlled administration of antidepressant medication produced greater expectancies of how much patients would improve during the trial. This expectancy difference may explain the higher response and remission rates that are observed in comparator versus placebo-controlled trials.

Impact of drug-eluting stents on outcomes of patients with end-stage renal disease undergoing percutaneous coronary revascularization.

BACKGROUND AND OBJECTIVE: End-stage renal disease (ESRD) patients on chronic dialysis are at heightened risk for target vessel revascularization (TVR) after coronary stenting. However, ESRD patients were excluded from the trials that demonstrated the superiority of drug-eluting stents (DES) over bare metal stents (BMS) in reducing TVR. We sought to identify the impact of stent type (DES versus BMS) on TVR and other cardiac adverse events in ESRD patients. METHODS: The study included 89 consecutive ESRD patients who underwent coronary stenting and were followed for greater than or equal to 9 months. TVR was the primary endpoint, and the secondary endpoint was a composite of death, myocardial infarction (MI) and TVR. Multivariate logistic regression models were used to adjust for differences in clinical and procedural characteristics. RESULTS: DES were used in 24 and BMS in 65 patients. The stent diameter was smaller (p = 0.008), but the stent length was longer (p = 0.006) in the DES group. TVR was required in 1 (4%) of DES and 17 (26%) BMS patients, while 8 (33%) DES and 39 (60%) BMS patients met the secondary endpoint. By multivariate logistic regression, DES use was associated with a significant reduction in TVR (OR 0.07, 95% CI 0.006-0.844; p = 0.036) and a significant reduction in death, MI and TVR (OR 0.11, 95% CI 0.022-0.513; p = 0.005). CONCLUSION: A high rate of ischemic events was noted for ESRD patients, regardless of stent type. However, in ESRD patients undergoing coronary revascularization, DES use is effective in reducing 9-month TVR and the composite of death, MI and TVR.

Influence of four retail food service cooling methods on the behavior of Clostridium perfringens ATCC 10388 in turkey roasts following heating to an internal temperature of 74 degrees C.

The influence of four food service cooling methods (CM) on growth of Clostridium perfringens ATCC 10388 in cooked turkey roasts was evaluated. Raw whole turkey roasts were inoculated with C. perfringens spores (approximately 4.23 log CFU per roast), vacuum packaged, and heated to an internal temperature of 74 degrees C. The cooked roasts were cooled as follows: whole roast cut into four quarters and held at 4 degrees C (CM1); whole roast held in a blast chiller (CM2); whole roast loosely wrapped and held at 4 degrees C (CM3); and whole roasts (three per bag) held at 4 degrees C (CM4). The roasts were analyzed for C. perfringens using Shahidi-Ferguson perfringens agar and anaerobic incubation (37 degrees C, 24 h). None of the cooling methods met the amended 2001 U.S. Food and Drug Administration Food Code guidelines for safe cooling of potentially hazardous foods. Times taken for roasts to cool from 57 to 21 degrees C using CM1, CM2, CM3, and CM4 were 2.27, 3.11, 6.22, and 8.71 h, respectively. Times taken for roasts (21 degrees C) to reach 5 degrees C ranged from 6.33 (CM1) to 19.45 h (CM4). Based on initial numbers of C. perfringens, no growth occurred in roasts cooled by CM1 or CM2, whereas numbers increased by 1.5 and 4.0 log in whole roasts cooled via CM3 and CM4, respectively. These findings indicate that certain food service cooling methods for whole cooked turkey roasts may result in proliferation of C. perfringens and increase the risk of foodborne illness by this pathogen.

Identity processing styles and the need for self-esteem in middle-aged and older adults.

This study was a test of the relationship between self-esteem and the identity processing styles of identity assimilation (i.e., maintaining consistent views of the self), accommodation (i.e., changing the self ), and a balance between consistency seeking and identity change. A community sample of 242 older adults ranging in age from forty to ninety-five (M = 63.31) completed measures of identity processing and self-esteem. Previous research has demonstrated that identity assimilation increases with age in order to maintain self-esteem in the domain of physical and cognitive functioning; this is referred to as the identity assimilation effect (IAE). Based on this research, a similar result was expected in the domain of personality. Although identity assimilation and balance predicted increases in self-esteem, and identity accommodation predicted decreases in self-esteem, as predicted, no interaction effects were observed. The results of this study suggest the IAE may be domain specific to physical and cognitive functioning.

College students' attitudes, practices, and knowledge of food safety.

A survey instrument was developed to assess attitudes, practices, and knowledge of food safety of college students in three U.S. geographic locations. Eight hundred twenty-four students in both food-related (one-third of sample) and nonfood-related disciplines completed the questionnaire during classroom periods. Data were analyzed to obtain total attitude, practice, and safety scores, with emphasis given to analyzing differences among disciplines and demographic characteristics. Mean scores were given for each of the survey items, and results from open-ended questions were discussed. Dietetic, food science, nutrition, and health majors had significantly (< or = 0.05) higher attitude scores than students majoring in other disciplines. No differences were found among disciplines for the practice scores, which ranged from 74 to 79% of the total possible practice score. Students enrolled in dietetics, arts and science (physical sciences), and veterinary medicine had significantly (< or = 0.05) higher knowledge scores, although the highest mean score (for dietetics) was only 74% of the total possible score. Women who had enrolled in a college course that included food safety information had significantly (< or = 0.05) higher attitude and practice scores. Such course enrollment led to both genders having significantly (< or = 0.05) higher knowledge scores than those without this opportunity. Implications were given for using these data to encourage college professors in food-related disciplines to become involved with the education of all future consumers, especially as the prevalence of food safety controversies is likely to increase as the food supply changes and technology becomes more sophisticated.

Erythropoietin can deteriorate glucose control in uraemic non-insulin-dependent diabetic patients.

Two patients with non-insulin-dependent diabetes mellitus (NIDDM) and moderate chronic renal failure experienced a worsening of glycaemic control when recombinant human erythropoietin (r-HuEPO) was introduced, leading to insulin therapy. A 71-year-old woman with a 20-year history of NIDDM had presented histologically documented diabetic nephropathy for 2 years during which glucose control was stabilized by a diet and glibenclamide 10 mg. In the 6 months following introduction of r-HuEPO, hyperglycaemic symptoms developed, and HbA1C increased from 8.9% to 12.3%. During this period, no intercurrent events occurred, except epistaxis due to accelerated hypertension one month after r-HuEPO was started. A 62-year-old man had a 15-year history of NIDDM, with proliferative retinopathy, macroproteinuria and chronic renal failure for 4 years. The day after the first injection of r-HuEPO, capillary glucose level rose dramatically. In both of these cases, antihypertensive treatment was increased and insulin introduced. The role of r-HuEPO in hyperglycaemia was probable in the first case and highly probable in the second. Reports about the effects of r-HuEPO on glucose metabolism in uraemic patients are conflicting. Short- and long-term effects can differ, although long-term benefit is likely. The fact that our patients were not dialized may have been important. Clinicians should be aware that glucose control may deteriorate with r-HuEPO, requiring some uraemic NIDDM patients to undergo insulin therapy.

Nutrition services for children with developmental disabilities and chronic illnesses in education programs.

OBJECTIVE: To determine the number of children attending school who require special nutrition services, types of nutrition services provided to children, involvement of registered dietitians in provision of nutrition services in the school setting, and continuing education needs of school nutrition personnel. DESIGN/SAMPLE: Pretested questionnaires were mailed to a national, systematic random sample of 600 school nutrition managers, 600 district school nutrition directors/supervisors, and 600 district special education program directors. Response rates were 32.7%, 46.2%, and 32.8%, respectively. STATISTICAL ANALYSES PERFORMED: Descriptive statistics were used to summarize data, including means, standard deviations, frequencies, and percentages. RESULTS: A large percentage of school nutrition managers (46%) reported that they served no children with special food and nutrition needs. Special food and nutrition needs most frequently encountered by all groups included food allergy, food intolerance, diabetes, and conditions with which feeding problems are associated. The skills of dietitians were used by 23% of school nutrition managers, 21% of district school nutrition directors/supervisors, and 15% of special education program directors. Continuing education needs were greatest for the areas of assessing liability, calculating macronutrient content of menus, modifying menus, and understanding the physical and emotional needs of children with special needs. APPLICATIONS/CONCLUSIONS: Communication between nutrition service providers and special education providers needs to be strengthened. A need exists to include nutrition in Individualized Education Programs for children in special education. Many opportunities are available for registered dietitians to provide consulting services for school nutrition programs related to special needs.

Development of financial management competencies for entry-level and advanced-level dietitians.

The major purposes in this study were to develop a list of financial management competencies for entry- and advanced-level dietitians, determine hospital foodservice directors'/chief dietitians' (practitioners) perceived importance of these competencies at both levels of practice, and determine educators' perceived importance of these competencies at the entry level. Drawing from the literature and the judgment of eight experts, we developed a list of 50 financial management competencies. Written questionnaires that included importance scales for the competencies were mailed to (a) practitioners in a random sample of 1,500 member hospitals of the American Hospital Association and (b) directors of Plan IV/V, Approved Preprofessional Practice, and Dietetic Internship programs. Response rates were 34% for the practitioners and 47% for the educators. Practitioners rated 8 competencies as important or very important for entry-level dietitians and 26 as important or very important for advanced-level dietitians. Practitioners rated all competencies higher for advanced-level dietitians than for those at the entry level, and educators rated all competencies higher than did practitioners. Content areas, identified by factor analysis, were similar for both levels of practice. Our findings indicate that emphasis in undergraduate and practice programs should be given to the eight competencies identified by practitioners and educators as most important. Our results also may be used for development and evaluation of graduate and continuing education programs and for specialty certification in foodservice management.

Natural killer cell activity in very low birth weight infants.

The exact role of natural killer (NK) cells in host defense is unclear, but they may be important as an early response to certain infections. We evaluated NK cell phenotype and activity in premature very low birth weight infants (VLBWI) (n = 52) with an average gestational age of 29.3 wk (24-35 wk) and an average birth weight of 1124 g (537-1480 g). All patients initially were evaluated within 7 d of birth. Samples also were obtained at 2, 4, and 6 wk in some infants. The proportion of mononuclear cells expressing the phenotypic marker of NK cells (NKH-1; CD56) was significantly lower in VLBWI than in adults (2.5 +/- 1.4 versus, 12.5 +/- 7.8%, p less than 0.0001) or term infants (2.5 +/- 1.4 versus 9.5 +/- 7.1%, p less than 0.0001). VLBWI also had significantly diminished NK activity expressed as the percentage of specific lysis compared with adults (4.7 +/- 4.4 versus 32.3 +/- 14.5%, p less than 0.0001) or term infants (4.7 +/- 4.4 versus 15.5 +/- 10.8%, p less than 0.0001). Both the number of cells expressing the NK phenotype and the NK lytic activity in VLBWI increased in the 6 wk after birth. NK activity in VLBWI was enhanced by IL-2 and in most cases by interferon-gamma.

Organizational culture: does it affect employee and organizational outcomes?

This study determined the type of organizational culture (bureaucratic, innovative, or supportive), and determined the relationships among organizational commitment, and behavioural outcomes (turnover, absenteeism, and productivity) in hospital foodservice departments. The sample included 423 foodservice employees from nine hospitals in eastern Canada and nine hospitals in East Tennessee. Two research instruments were used for data collection. The historical data instrument, completed by the department director, obtained data to calculate productivity, turnover, and absenteeism rates. The four-part employee instrument included the 24-item Organizational Culture Index, the 15-item Organizational Commitment Questionnaire, five questions to determine perceptions of job satisfaction, and demographic items. Multiple linear regression analysis tested relationships among variables. The predominant culture was bureaucratic (14.9 +/- 4.3 of a possible 24). Means were lower for innovative (13.2 +/- 4.3) and supportive (12.7 +/- 5.0) cultures. Supportive and innovative cultures had positive relationships with both job satisfaction and organizational commitment. Organizational culture was not related to turnover, absenteeism, or productivity. Mean productivity was 3.8 +/- 3.2 meals per labour hour, ranging from 0.8 to 15.1. Employees rated satisfaction with co-workers highest, and satisfaction with pay lowest. These findings will help hospital foodservice managers understand the relationship of culture to organizational and employee outcomes; changing culture may improve desired outcomes.

Selection criteria for approved preprofessional practice programs: are they different from those for dietetic internships?

Using a mailed questionnaire, we surveyed the directors of 41 approved preprofessional practice programs (AP4) listed in the Directory of Dietetic Programs 1990 and nine programs approved by The American Dietetic Association's Council on Education in December 1989 to determine the relative importance of admission criteria used to select students for AP4s. We compared the results of this study with those of an earlier survey of dietetic internship directors. The AP4 and dietetic internship directors gave significantly different importance ratings to elective courses in professional sciences and courses in the biological/physical sciences. Unlike dietetic internship directors, AP4 directors rated Graduate Record Examination (GRE) score highest (1.4 +/- 1.7 on a 10-point scale). AP4 directors' rating of grade point average (1.8 +/- 1.3) and professional courses (1.9 +/- 1.2) was similar to the internship directors' rating of these criteria (1.7 +/- 0.9 and 1.7 +/- 1.0, respectively). Results indicate that AP4 and internship directors seek similar qualities in students, but that GRE score is more important to AP4 directors. The AP4 directors' emphasis on GRE score may be explained, in part, by the fact that 76% (38 of 50) of these programs are affiliated with a university program, and of those 38 programs, 29 (88%) require graduate credit as a component of the AP4. These data are important to Plan IV/V faculty advisers because students may have misconceptions about differences in AP4 and internship selection criteria.

Marketing nutrition in restaurants: a survey of current practices and attitudes.

This study sought to determine attitudes toward nutrition, nutrition marketing practices, the relationship between attitudes toward nutrition and nutrition marketing practices, and nutrition training practices in restaurants. A written questionnaire was mailed to 200 research and development (R & D) directors in restaurant companies included in Restaurants & Institutions' list of top 400 foodservice organizations ranked by sales. Seventy (35%) responded. Most R & D directors did not think they were responsible for improving the health of their consumers. A positive relationship existed between attitudes toward nutrition and nutrition marketing practices (P = .013). Forty-four reported that they marketed nutrition and planned to add nutritious menu items in the future. Forty-six reported that nutritious meal options represented 0 to 10% of total sales. Nutrition information was provided to consumers by 27 restaurant companies but such information often had to be requested. The American Heart Association was a popular source of nutrition and menu-planning information. Twelve companies employed a registered dietitian, and 14 used registered dietitians as consultants. Nutrition-related training for restaurant employees was limited. These findings indicate that dietitians have opportunities to market their skills in developing nutritious menu items and providing staff training. Also, dietitians should encourage consumers (especially those with special dietary needs) to let restaurant managers know their menu and nutrition information needs.