Dietary patterns, insulin sensitivity and inflammation in older adults.

Background/objectivesSeveral studies have linked dietary patterns to insulin sensitivity and systemic inflammation, which affect risk of multiple chronic diseases. The purpose of this study was to investigate the dietary patterns of a cohort of older adults, and to examine relationships of dietary patterns with markers of insulin sensitivity and systemic inflammation.Subjects/methodsThe Health, Aging and Body Composition (Health ABC) Study is a prospective cohort study of 3075 older adults. In Health ABC, multiple indicators of glucose metabolism and systemic inflammation were assessed. Food intake was estimated with a modified Block food frequency questionnaire. In this study, dietary patterns of 1751 participants with complete data were derived by cluster analysis.ResultsSix clusters were identified, including a 'healthy foods' cluster, characterized by higher intake of low-fat dairy products, fruit, whole grains, poultry, fish and vegetables. In the main analysis, the 'healthy foods' cluster had significantly lower fasting insulin and homeostasis model assessment of insulin resistance values than the 'breakfast cereal' and 'high-fat dairy products' clusters, and lower fasting glucose than the 'high-fat dairy products' cluster (P≤0.05). No differences were found in 2-h glucose. With respect to inflammation, the 'healthy foods' cluster had lower interleukin-6 than the 'sweets and desserts' and 'high-fat dairy products' clusters, and no differences were seen in C-reactive protein or tumor necrosis factor-α.ConclusionsA dietary pattern high in low-fat dairy products, fruit, whole grains, poultry, fish and vegetables may be associated with greater insulin sensitivity and lower systemic inflammation in older adults

Understanding Prediabetes Through Facebook: Pilot Study Protocol and Lessons Learned

Purpose/Background: Type 2 Diabetes is a serious contributor to mortality and morbidity. Rural populations (including those in Mountain West regions) exhibit greater health disparities than their urban counterparts for many conditions, including diabetes. It is therefore vital to address this important health issue, especially among rural populations. One way to address diabetes is with prevention, starting with enhanced detection of prediabetes. According to the CDC, more than 84 millions Americans (one in three adults) has prediabetes, but nine out of ten are not aware of their condition, which hampers prevention efforts. Infodemiology has been used successfully to track health information found on social media. Our project aims to find indicators of prediabetes through Facebook content, with a long-term goal of developing an effective social media screening tool for prediabetes. Materials & Methods: This study had an exploratory retrospective design (the study protocol has been published; Xu, Litchman, Geeet al., 2018 JMIR Research Protocols). Utilizing electronic medical records from a Mountain West region family medicine clinic, we recruited 17 patients diagnosed with prediabetes who were willing to share their Facebook posts. Participants completed a clinic session where they responded to a number of surveys (e.g., Facebook Intensity Scale, Prediabetes Online Community Engagement Scale, Computer-Mediated Social Support Scale) and provided us with their Facebook account information. We then accessed and coded all Facebook posts for the 6-month period surrounding their prediabetes diagnosis (3-months pre through 3-months post-diagnosis; see Figure 1). Coding included meta-data (e.g., time of post, post type), post text/visuals, social aspects of the post (e.g., comments, reactions, shares), and content of interest (e.g., health, physical symptoms, lifestyle factors, medical experiences, food etc.). Results: Descriptive information about participant demographics and their responses to surveys are provided (see Table 1). We are currently compiling the coded data and will use a mixed-method protocol for analyses. This includes both qualitative content analysis to identify themes as well as a quantitative approach to examine potential differences between the 3-months prediagnosis and the 3-months postdiagnosis for our participants. While we were able to code data for 17 patients, due to unanticipated barriers in recruitment and coding we did not meet our planned goal of 20 patients. To assist those planning on conducting this type of social media research, we will discuss some of these issues including the importance of having a large team of coders who can work simultaneously. Discussion/Conclusion: Data from this project should provide an initial taxonomy of prediabetes indicators indentifiable within a social media context. Future studies, with larger samples, can test the utility of the taxonomy on predicting prediabetes status from Facebook posts. We also hope that our lessons learned information will be helpful to other researchers working on social media health studies. The ultimate goal of our research is to develop an automated method to identify social media users who are likely to have prediabetes. This would be especially helpful for those who are unaware of their health condition, as identification can lead to efforts that can prevent the progression of prediabetes to diabetes

Questioning Classic Patient Classification Techniques in Gait Rehabilitation: Insights from Wearable Haptic Technology

Classifying stroke survivors based on their walking abilities is an important part of the gait rehabilitation process. It can act as powerful indicator of function and prognosis in both the early days after a stroke and long after a survivor receives rehabilitation. This classification often relies solely on walking speed; a quick and easy measure, with only a stopwatch needed. However, walking speed may not be the most accurate way of judging individual’s walking ability. Advances in technology mean we are now in a position where ubiquitous and wearable technologies can be used to elicit much richer measures to characterise gait. In this paper we present a case study from one of our studies, where within a homogenous group of stroke survivors (based on walking speed classification) important differences in individual results and the way they responded to rhythmic haptic cueing were identified during the piloting of a novel gait rehabilitation technique

Successful ecosystem-based management of Antarctic krill should address uncertainties in krill recruitment, behaviour and ecological adaptation

Antarctic krill, Euphausia superba, supports a valuable commercial fishery in the Southwest Atlantic, which holds the highest krill densities and is warming rapidly. The krill catch is increasing, is concentrated in a small area, and has shifted seasonally from summer to autumn/winter. The fishery is managed by the Commission for the Conservation of Antarctic Marine Living Resources, with the main goal of safeguarding the large populations of krilldependent predators. Here we show that, because of the restricted distribution of successfully spawning krill and high inter-annual variability in their biomass, the risk of direct fishery impacts on the krill stock itself might be higher than previously thought. We show how management benefits could be achieved by incorporating uncertainty surrounding key aspects of krill ecology into management decisions, and how knowledge can be improved in these key areas. This improved information may be supplied, in part, by the fishery itself

Patient initiated outpatient follow up in rheumatoid arthritis:six year randomised controlled trial

Objectives To determine whether direct access to hospital review initiated by patients with rheumatoid arthritis would result in improved clinical and psychological outcome, reduced overall use of healthcare resources, and greater satisfaction with care than seen in patients receiving regular review initiated by a rheumatologist. Design Two year randomised controlled trial extended to six years. Setting Rheumatology outpatient department in teaching hospital. Participants 209 consecutive patients with rheumatoid arthritis for over two years; 68 (65%) in the direct access group and 52 (50%) in the control group completed the study (P = 0.04). Main outcome measures Clinical outcome: pain, disease activity, early morning stiffness, inflammatory indices, disability, grip strength, range of movement in joints, and bone erosion. Psychological status: anxiety, depression, helplessness, self efficacy, satisfaction, and confidence in the system. Number of visits to hospital physician and general practitioner for arthritis. Results Participants were well matched at baseline. After six years there was only one significant difference between the two groups for the 14 clinical outcomes measured (deterioration in range of movement in elbow was less in direct access patients). There were no significant differences between groups for median change in psychological status. Satisfaction and confidence in the system were significantly higher in the direct access group at two, four, and six years: confidence 9.8 v 8.4, 9.4 v 8.0, 8.7 v 6.9; satisfaction 9.3 v 8.3, 9.3 v 7.7, 8.9 v 7.1 (all P < 0.02). Patients in the direct access group had 38% fewer hospital appointments (median 8 v 13, P < 0.0001). Conclusions Over six years, patients with rheumatoid arthritis who initiated their reviews through direct access were clinically and psychologically at least as well as patients having traditional reviews initiated by a physician. They requested fewer appointments, found direct access more acceptable, and had more than a third fewer medical appointments. This radical responsive management could be tested in other chronic diseases

Development of the preterm gut microbiome in twins at risk of necrotising enterocolitis and sepsis

The preterm gut microbiome is a complex dynamic community influenced by genetic and environmental factors and is implicated in the pathogenesis of necrotising enterocolitis (NEC) and sepsis. We aimed to explore the longitudinal development of the gut microbiome in preterm twins to determine how shared environmental and genetic factors may influence temporal changes and compared this to the expressed breast milk (EBM) microbiome. Stool samples (n = 173) from 27 infants (12 twin pairs and 1 triplet set) and EBM (n = 18) from 4 mothers were collected longitudinally. All samples underwent PCR-DGGE (denaturing gradient gel electrophoresis) analysis and a selected subset underwent 454 pyrosequencing. Stool and EBM shared a core microbiome dominated by Enterobacteriaceae, Enterococcaceae, and Staphylococcaceae. The gut microbiome showed greater similarity between siblings compared to unrelated individuals. Pyrosequencing revealed a reduction in diversity and increasing dominance of Escherichia sp. preceding NEC that was not observed in the healthy twin. Antibiotic treatment had a substantial effect on the gut microbiome, reducing Escherichia sp. and increasing other Enterobacteriaceae. This study demonstrates related preterm twins share similar gut microbiome development, even within the complex environment of neonatal intensive care. This is likely a result of shared genetic and immunomodulatory factors as well as exposure to the same maternal microbiome during birth, skin contact and exposure to EBM. Environmental factors including antibiotic exposure and feeding are additional significant determinants of community structure, regardless of host genetics

The latent stem cell population is retained in the hippocampus of transgenic Huntington's disease mice but not wild-type mice

The demonstration of the brain's ability to initiate repair in response to disease or injury has sparked considerable interest in therapeutic strategies to stimulate adult neurogenesis. In this study we examined the effect of a progressive neurodegenerative condition on neural precursor activity in the subventricular zone (SVZ) and hippocampus of the R6/1 transgenic mouse model of Huntington's disease (HD). Our results revealed an age-related decline in SVZ precursor numbers in both wild-type (WT) and HD mice. Interestingly, hippocampal precursor numbers declined with age in WT mice, although we observed maintenance in hippocampal precursor number in the HD animals in response to advancement of the disease. This maintenance was consistent with activation of a recently identified latent hippocampal precursor population. We found that the small latent stem cell population was also maintained in the HD hippocampus at 33 weeks, whereas it was not present in the WT. Our findings demonstrate that, despite a loss of neurogenesis in the HD hippocampus in vivo, there is a unique maintenance of the precursor and stem cells, which may potentially be activated to ameliorate disease symptoms

A typology of alcohol consumption among young people – A narrative synthesis

Background: Currently, alcohol consumption levels are significantly higher among younger age groups. However, previous research has noted the diversity of motivations and patterns. These patterns of drinking have yet to be synthesised into a typology. The aim of the current study was to synthesise information from studies that produced types of alcohol consumption among young people. Method: Quantitative and qualitative literature investigating the different types of drinkers among young people [aged 12–24 years], published in peer reviewed journals, were eligible for inclusion in this systematic review. MEDLINE, PsychInfo and CINAHL were systematically searched for relevant articles published between January 1st 2000 and December 31st 2014. Included papers were critically appraised. A narrative synthesis approach was employed based on guidance from the UK Economic and Social Research Council. Results: In total, 13 studies were eligible for inclusion: 11 quantitative, one qualitative and one mixed methods. Six classes of drinkers were formed within this typology. Abstainers reported no alcohol consumption. Light drinkers reported drinking small amounts of alcohol infrequently. In comparison, social and hedonistic drinkers drank most in social situations and to have fun. Heavy and harmful consumers reported increased volume and frequency of consumption including harmful consequences. Conclusion: Currently, policy makers are attempting to combat the high levels of harmful alcohol consumption among young people. The current typology provides guidance for targeted interventions in addition to a practical analytic tool in future research

Exploring the components, asymmetry and distribution of relationship quality in wild Barbary macaques (Macaca sylvanus)

Social relationships between group members are a key feature of many animal societies. The quality of social relationships has been described by three main components: value, compatibility and security, based on the benefits, tenure and stability of social exchanges. We aimed to analyse whether this three component structure could be used to describe the quality of social relationships in wild Barbary macaques (Macaca sylvanus). Moreover, we examined whether relationship quality was affected by the sex, age and rank differences between social partners, and investigated the asymmetric nature of social relationships. We collected over 1,900 hours of focal data on seven behavioural variables measuring relationship quality, and used principal component analysis to investigate how these variables clustered together. We found that relationship quality in wild Barbary macaques can be described by a three component structure that represents the value, compatibility and security of a relationship. Female-female dyads had more valuable relationships and same-age dyads more compatible relationships than any other dyad. Rank difference had no effect on the quality of a social relationship. Finally, we found a high degree of asymmetry in how members of a dyad exchange social behaviour. We argue that the asymmetry of social relationships should be taken into account when exploring the pattern and function of social behaviour in animal societies