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Diet quality indices are a practical, cost-effective method to evaluate dietary patterns, yet few have investigated diet quality in athletes. This study describes the relative validity and reliability of the recently developed Athlete Diet Index (ADI). Participants completed the electronic ADI on two occasions, two weeks apart, followed by a four-day estimated food record (4-dFR). Relative validity was evaluated by directly comparing mean scores of the two administrations (mAdm) against scores derived from 4-dFR using Spearman’s rank correlation coefficient and Bland-Altman (B-A) plots. Construct validity was investigated by comparing mAdm scores and 4-dFR derived nutrient intakes using Spearman’s coefficient and independent t-tests. Test-retest reliability was assessed using paired t-tests, intra-class correlation coefficients (ICC) and B-A plots. Sixty-eight elite athletes (18.8 ± 4.2 years) from an Australian sporting institute completed the ADI on both occasions. Mean score was 84.1 ± 15.2 (range: 42.5-114.0). The ADI had good reliability (ICC=0.80, 95% CI: 0.69, 0.87; p<0.001), and B-A plots (mean 1.9; LOA -17.8, 21.7) showed no indication of systematic bias (y=4.57-0.03*x) (95% CI: -0.2, 0.1; p=0.70). Relative validity was evaluated in 50 athletes who completed all study phases. Comparison of mAdm scores to 4-dFR derived scores was moderate (rs=0.69; p<0.001) with no systematic bias between methods of measurement (y=6.90-0.04*x) (95% CI: -0.3, 0.2; p=0.73). Higher scores were associated with higher absolute nutrient intake consistent with a healthy dietary pattern. The ADI is a reliable tool with moderate validity, demonstrating its potential for application to investigate the diet quality of athletes.
This paper uses evidence from a previously unresearched ecclesiastical textile associated with Archbishop John Morton (c 1420−1500) to generate new insights into the material culture of the Roman Catholic faith before, during and after the penal period in England (c 1558−1829). This composite textile was initially thought to be made up of fragments of a late 1400s cope bearing Morton’s rebus, reconfigured as an altar frontal, which had survived in the house of an important Roman Catholic family. The embroidered motifs include a unique Lily Crucifix. The textile’s complex biography is ‘unpicked’ using physical and textual evidence to understand its changing forms, roles and significance. Analysis of the material and construction, combined with evidence gained through X-radiography, showed the frontal to be composed of parts of a cope and at least one other vestment, with a now missing image of the Annunciation. Mapping the stages of fragmentation, removal and re-modelling demonstrates the transformation of significant mainstream vestments into other forms. The paper illuminates aspects of Morton’s faith and provides new insights into the practices of recusant Roman Catholics.
OBJECTIVES/GOALS: Flavorings differ between brands and tobacco products, potentially altering the sensory perceptions. This study aimed to examine discrepancies in flavor preference across various non-cigarette tobacco products among a national representative sample of US adult regular tobacco users. METHODS/STUDY POPULATION: Data from the Population Assessment of Tobacco and Health (PATH) Study Wave 3 (W3) were used. Weighted prevalence of flavor preference for various tobacco products, including electronic nicotine delivery systems (ENDS), traditional cigars, cigarillos/filtered cigars, hookah and snus/smokeless, was presented for 9,037 adult current and new former users of multiple flavored tobacco products. Within-subject flavor discrepancies were assessed using generalized estimating equations (GEE) models considering the complex sampling design of the PATH study. RESULTS/ANTICIPATED RESULTS: Most regular users of a flavored tobacco products reported using one flavor category per product. Fruit flavors, followed by tobacco, were the most common flavor categories among ENDS (32% and 25%, respectively) and hookah users (44% and 36%, respectively). Tobacco flavor was the most common among regular users of traditional cigars (80%), cigarillos/filtered cigars (55%), and smokeless tobacco (79%). Polytobacco users of ENDS and traditional cigars had the largest discrepancy, where about 68-76%% used different flavor categories when switching products. Conversely, polytobacco users of traditional cigars and cigarillos/filtered cigars had the lowest discrepancy (23-25%). DISCUSSION/SIGNIFICANCE OF IMPACT: Many consumers of multiple tobacco products had different flavor preferences when switching between products. In the event of a partial or full flavor ban for ENDS, these findings raise questions about consumer loyalty to a particular tobacco product or a particular flavor category. Conflict of Interest Description: MLG serves as a paid consultant for Johnson & Johnson and has received research grant from Pfizer, manufacturers of smoking cessation medications. The other authors have no conflicts to declare. CONFLICT OF INTEREST DESCRIPTION: MLG serves as a paid consultant for Johnson & Johnson and has received research grant from Pfizer, manufacturers of smoking cessation medications. The other authors have no conflicts to declare.
OBJECTIVES/GOALS: Wheezing has been shown to be associated with use of cigarettes, and more recently, electronic nicotine delivery systems (ENDS). This study assessed the association of poly use of tobacco products with wheezing among a national representative sample of US adult current tobacco users. METHODS/STUDY POPULATION: Data from the Population Assessment of Tobacco and Health (PATH) Study Wave 3 (W3) were used. Weighted prevalences of self-reported wheezing and related respiratory symptoms for non-users compared to users of cigarettes, ENDS, cigars, and any combination of these products (poly use of tobacco products) were presented for 28,082 adults. The cross-sectional association of tobacco use with self-reported wheezing and other related respiratory symptoms was assessed using weighted multivariable and ordinal logistic regression with consideration of complex sampling design. RESULTS/ANTICIPATED RESULTS: Most adults who reported on wheezing symptoms did not currently use cigarettes, ENDS or cigars (79%), 15% used cigarettes, 3% used a combination of cigarettes, ENDS and cigars, 1% used ENDS, and 1% used cigars. Significantly higher odds of ever had wheezing or whistling in chest at any time in the past was observed among current cigarette (adjusted OR: 2.62, 95%CI: 2.35, 2.91), ENDS (1.49, 95%CI: 1.14, 1.95), and poly users (2.67, 95%CI: 2.26, 3.16) compared to non-users. No differences were seen for cigar use. Polytobacco use was associated with a higher odds of ever wheezing when compared to ENDS (1.61, 95%CI: 1.19, 2.17) and cigar use (2.87, 95%CI: 1.93, 4.26), but not cigarettes. DISCUSSION/SIGNIFICANCE OF IMPACT: Wheezing is associated with the use of cigarettes, ENDS, or any combination of cigarette, ENDS and cigars likely due to the inhalation of noxious chemicals and gases found in the smoke of cigarettes and ENDS that are likely to increase the odds of experiencing wheezing. CONFLICT OF INTEREST DESCRIPTION: MLG serves as a paid consultant for Johnson & Johnson and has received research grant from Pfizer, manufacturers of smoking cessation medications. The other authors have no conflicts to declare.
Nerve transfer surgery for patients with nerve and spinal cord injuries can result in dramatic functional improvements. As a result, interdisciplinary complex nerve injury programs (CNIPs) have been established in many Canadian centers, providing electrodiagnostic and surgical consultations in a single encounter. We sought to determine which allied health care services are included in Canadian CNIPs, at the 3rd Annual Canadian Peripheral Nerve Symposium. Twenty CNIPs responded to a brief survey and reported access as follows: occupational therapy = 60%, physiotherapy = 40%, social work = 20%, and mental health = 10%. Access to allied health services is variable in CNIPs across Canada, possibly resulting in heterogeneity in patient care.
Introduction: Outpatient oncology clinics have become the mainstay of cancer treatment, but their limited services and hours of operation often lead to emergency department (ED) referrals. With Canada's aging population and cancer survival rates improving, cancer-related ED visits are becoming a significant aspect of emergency medicine. A cancer-related visit to the ED is associated with unique challenges for patients, their caregivers and clinicians. This study focuses on understanding the ED experience of patients and their caregivers sent from an outpatient oncology clinic to a separate affiliated large academic hospital. Methods: A descriptive, phenomenological study of interviews was conducted using the method of Giorgi. The sample included 12 participants (n = 9 patients, 3 caregivers) referred to the ED at a large academic hospital (i.e., Toronto General Hospital, TGH) following a same-day outpatient oncology appointment at an affiliated cancer centre (i.e., Princess Margaret Hospital, PMH). Interviews continued until thematic saturation. All transcripts were analyzed by 2 reviewers with bracketing to ensure accuracy. Results: Four themes were identified from analysis: (1) communication; (2) expectations; (3) care and symptom management and (4) potential improvements. Overall patients and caregivers felt communication between PMH and TGH, and from providers could have been better. Many felt there was a break-down in communication as they did not expect to go through the usual ED triage process, which caused additional anxiety and frustration with the wait times. The majority felt their symptoms were managed in a timely manner and reported the staff to be friendly, caring and professional; however, often felt forgotten and anxious due to a lack of “checking-in”. Their experience could have been improved by receiving more information on the process, a more welcoming environment and separate waiting area or private room for those who are immunocompromised. Conclusion: Although referral from an outpatient oncology clinic to the ED of an affiliated hospital is a common process within Canada, this is the first study to explore the patient and caregiver experience. Understanding the patient and caregiver experience is valuable for identifying quality improvement initiatives. Our analysis revealed the patient and caregiver experience could be improved with better communication and expectation setting regarding the ED process before and throughout the visit.
Introduction: Nearly 50% of Canadians will develop cancer in their lifetime (1), and the vast majority of those with cancer will visit the emergency department (ED) in their last 6 months of life (2). Considering the aging population, improvement in cancer survival and current practice of managing cancer in outpatient settings, cancer-related emergencies are becoming a significant aspect of emergency medicine. The presenting symptoms and rates of hospitalization for cancer-related ED visits have largely been established. The current study characterizes the patterns of ED utilization and time-course of events for cancer-related ED visits following same-day outpatient oncology appointments resulting in admission to hospital compared to those not admitted. Methods: A retrospective chart-review was used to identify 231 adult patients who visited the ED at a large academic hospital (i.e., Toronto General Hospital) following a same-day outpatient oncology appointment at an affiliated cancer centre (i.e., Princess Margaret Hospital) from March to May 2019, using administrative data. Results: All visits occurred on weekdays (avg = 4 visits/d) and 57% of visits resulted in hospitalization. Between those admitted and not admitted to hospital, there was no difference in triage time [17:23 + 0:14 vs. 17:01 + 0:20 h, p = 0.47; mean(SD)]. Visits resulting in hospitalization were more urgent (median CTAS score = 2 vs. 3, p < 0.001) and required more consultation services (64 vs. 17 % of visits, p < 0.001), but did not differ for imaging (36 vs. 33 % of visits, p = 0.63). The length of stay in the ED was longer for those admitted [16.6(0.9) vs. 5.3(0.3) h, p < 0.01), they waited longer for their initial assessment [2.6(1.9) vs. 1.8(1.3) h, p < 0.01) and spent 10.1(9.9) h waiting for a bed on the ward. There was no difference in time from initial assessment to disposition, imaging or consult reports (p > 0.05) between groups. The patients transferred from oncology clinics were triaged at 17:13(0:11) h compared to 13:56(0:03) h for all ED visits during the same time frame. Conclusion: Most patients sent from oncology clinics to the ED are admitted, and when admitted they spend an additional 10 h waiting for a bed on the ward. These patients tend to arrive later in the day compared to other ED patients. Understanding utilization patterns and time-course of events allows for objective identification of quality improvement initiatives. 1 Canadian Cancer Society, 2015 2 Barbera et al. CMAJ, 2010
The uncertainty surrounding high intakes of folic acid and associations with cognitive decline in older adults with low vitamin B12 status has been an obstacle to mandatory folic acid fortification for many years. We estimated the prevalence of combinations of low/normal/high vitamin B12 and folate status and compared associations with global cognitive function using two approaches, of individuals in a population-based study of those aged ≥50 years in the Republic of Ireland. Cross-sectional data from 3781 men and women from Wave 1 of The Irish Longitudinal Study on Ageing were analysed. Global cognitive function was assessed by the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Prevalence estimates for combinations of vitamin B12 (plasma vitamin B12 < or ≥258 pmol/l) and folate (plasma folate ≤ or >45·3 nmol/l) concentrations were generated. Negative binomial regression models were used to investigate the associations of vitamin B12 and folate status with global cognitive function. Of the participants, 1·5 % (n 51) had low vitamin B12 (<258 pmol/l) and high folate (>45·3 nmol/l) status. Global cognitive performance was not significantly reduced in these individuals when compared with those with normal status for both B-vitamins (n 2433). Those with normal vitamin B12/high folate status (7·6 %) had better cognitive performance (MMSE: incidence rate ratio (IRR) 0·82, 95 % CI 0·68, 0·99; P = 0·043, MoCA: IRR 0·89, 95 % CI 0·80, 0·99; P = 0·025). We demonstrated that high folate status was not associated with lower cognitive scores in older adults with low vitamin B12 status. These findings provide important safety information that could guide fortification policy recommendations in Europe.
Olanzapine is prescribed in the treatment of schizophrenia and BPAD. It is not licensed for personality disorders, behavioural issues or in patients with opiate addiction.This audit sought to identify the number of opiate dependent patients in a tertiary referral centre on olanzapine and the reason why.
All patients attending one sector had their notes examined over a three year period to see whether they are or were on olanzapine. All patients were opiate dependent and prescribed methadone.Parameters looked at included Axis 1 or 2 diagnosis, previous psychiatric in-patient admissions, forensic history and whether fasting lipids and glucose were checked.
169 charts were reviewed.Of these, 37 patients either were on or had been on olanzapine (21.9% overall).20 of these patients (11.8%) had an Axis 1 disorder, 17(10%) had behavioural diffciulties.Of the 20 patients with an Axis 1 disorder, 18 of them had an in-patient hospital admission.Only 7 of 17 patients on olanzapine with behavioural issues had an in-patient admission.All patients with behavioural difficulties had a forensic history and 16/17 had custodial sentences.15 of the 20 patients with Axis 1 diagnoses served custodial sentences.
A significant percentage of patients were prescribed olanzapine off license with no clinical indication.This is a worrying finding due to the abuse potential of olanzapine and longer term metabolic effects.Caution should be taken with prescribing olanzapine to opiate addicts who abuse it for its sedative effect.The value of this study is that it is one of the few to date to describe this problem.
Psychotic depression is widely accepted as a specific subtype of unipolar major depression. Magnetic resonance imaging studies have begun to investigate the neurobiological changes that differentiate this subtype of major depression from non-psychotic depression. Any differences may eventually be useful in aiding diagnosis. This review collates the currently available evidence, with the aim of directing future study.
A systematic search of the Medline, PubMed & Embase databases was used to identify all articles comparing structural or functional magnetic resonance imaging (MRI) differences between psychotic and non-psychotic depression. The results were then collated and organised according to brain region.
Decreased frontal cortex grey matter volumes and, to a lesser degree, insula cortex volumes differentiate psychotic from non-psychotic depression. fMRI studies show associations between altered activity in these two regions and cognitive impairments in patients with psychotic depression.
The volumes of putative emotional processing regions including the amygdala, hippocampus and anterior cingulate show no difference between psychotic and non-psychotic depression.
Structural and functional changes in the higher associative regions of the frontal and insula cortices differentiate between psychotic and nonpsychotic depression to a greater degree than changes in putative emotional processing regions. The numbers of studies available and the sample sizes involved are both small but future studies aimed at understanding the neurobiology of psychotic depression may benefit from a more detailed assessment of these two regions.
Pregnancy may cause somatic alterations and possible transformation in women's behaviour, emotions and cognition.
To analyse monthly somatic and cognitive changes in pregnancy.
To examine the pattern of cognitive (depressed mood, lack of self-esteem, guilt, lack of concentration, sensitivity to criticism, thoughts of death) and somatic (decreased energy, feelings of heavy limbs and feeling worse in the morning) symptoms throughout the 9 months of pregnancy.
N=374 women were interviewed once (6 weeks postnatal) using a modified version of the Structured Clinical Interview for DSM IV. Women were asked whether they had experienced each symptom at any time during pregnancy and if they said yes, the monthly symptom occurrence was assessed. Repeated measures General Linear Model analysis was used.
There were both linear (a) and quadratic (b) significant changes over time for sensitivity to criticism (Fa=20.9(1), Fb=7.02(1), pa,b=0.00), lack of concentration (Fa=37.0(1); Fb=10.3(1); pa,b=0.00), decreased energy (Fa=13.4(1), Fb=62.6(1); pa,b=0.00) and feelings of heavy limbs(Fa=92.9(1), Fb=67.7(1) pa,b=0.00). Guilt (F=0.00(1); p=0.93) showed no change over pregnancy, lack of self-esteem (F=10.15(1); p= 0.00) showed linear significance while depressed mood (F=5.15(1); p= 0.02) showed quadratic significance. After controlling for covariates, no significant interactions between them and all symptoms were found.
Cognitive symptoms changed throughout pregnancy as much as somatic symptoms. Most symptoms showed a different pattern from depressed mood (Figure 1). Sensitivity to criticism, lack of concentration, feelings of heavy limbs and decreased energy were especially high during late pregnancy.
Why patients with psychosis use cannabis remains debated. The self-medication hypothesis has received some support but other evidence points towards an alleviation of dysphoria model. This study investigated the reasons for cannabis use in first-episode psychosis (FEP) and whether strength in their endorsement changed over time.
FEP inpatients and outpatients at the South London and Maudsley, Oxleas and Sussex NHS Trusts UK, who used cannabis, rated their motives at baseline (n = 69), 3 months (n = 29) and 12 months (n = 36). A random intercept model was used to test the change in strength of endorsement over the 12 months. Paired-sample t-tests assessed the differences in mean scores between the five subscales on the Reasons for Use Scale (enhancement, social motive, coping with unpleasant affect, conformity and acceptance and relief of positive symptoms and side effects), at each time-point.
Time had a significant effect on scores when controlling for reason; average scores on each subscale were higher at baseline than at 3 months and 12 months. At each time-point, patients endorsed ‘enhancement’ followed by ‘coping with unpleasant affect’ and ‘social motive’ more highly for their cannabis use than any other reason. ‘Conformity and acceptance’ followed closely. ‘Relief of positive symptoms and side effects’ was the least endorsed motive.
Patients endorsed their reasons for use at 3 months and 12 months less strongly than at baseline. Little support for the self-medication or alleviation of dysphoria models was found. Rather, patients rated ‘enhancement’ most highly for their cannabis use.
This study investigated the relationship between severe childhood abuse and cognitive functions in first-episode psychosis patients and geographically-matched controls. Reports of any abuse were associated with lower scores in the executive function domain in the control group. However, in contrast with our hypothesis, no relationships were found amongst cases.
GAD and disturbed sleep are prevalent, debilitating, and frequently comorbid problems for which successful treatment remains limited. The adoption of regular exercise can promote sleep but whether it does so for GAD patients is unknown.
To quantify the magnitude of the effect of six weeks of either twice weekly resistance (RET) or aerobic exercise training (AET) on self-reported sleep among GAD patients
Thirty sedentary women, aged 18-37 years, with a primary DSM-IV diagnosis of GAD were randomized to RET, AET, or wait list (WL). RET involved two weekly sessions of lower-body weightlifting. AET involved two weekly sessions of leg cycling matched to RET on exercise time, work performed and weekly load progression. Participants completed the Pittsburgh Sleep Diary daily for seven days at baseline and week six. Sleep outcomes included total sleep time (TST), bedtime, time in bed (TIB), sleep onset latency (SOL), wakefulness after sleep onset, and sleep efficiency, calculated as TST divided by TIB and expressed as a percentage. Hedges’ d effect sizes and associated 95% confidence intervals (95% CI) were calculated for each exercise condition compared to WL. Twenty participants provided complete data and were included in analyses.
RET decreased weekend TST (d=-1.23; 95%CI:-2.27, −0.18), TIB (d=-2.01; 95%CI:-3.29, −0.72), and SOL (d=-2.05; 95%CI:-3.34, −0.76), and increased weekend sleep efficiency (d=1.32; 95%CI:0.16, 2.47). AET reduced weekend SOL (d=-1.87, 95%CI:-3.17, −0.56) and TIB (d=-1.45, 95%CI:-2.68, −0.23).
Preliminary findings suggest that short-term exercise training improves self-reported sleep parameters among GAD patients.
Neonates with CHD are at increased risk of developing necrotising enterocolitis due to mesenteric hypoperfusion. Necrotising enterocolitis results in repeated feed interruptions contributing to poor growth during the early post-operative phase. Poor weight gain and longer hospital stay are risk factors for death in neonates with CHD. Abdominal radiography is used as a diagnostic tool for necrotising enterocolitis; however, its utility is limited in the early stages of necrotising enterocolitis when pneumatosis intestinalis is absent. Calprotectin is a neutrophil activation biomarker, and elevated levels are evident in inflammatory diseases such as necrotising enterocolitis. The aim of this study was to determine whether there is a correlation between faecal calprotectin concentration and gut inflammation in neonates with CHD. This prospective single-centre study recruited newly diagnosed term patients with duct-dependent CHD between March 2018 and March 2019. Faecal calprotectin concentrations were measured in post-surgical patients using enzyme-linked immunosorbent assay methods. A total of 30 patients were included in the analysis. Calprotectin concentration for patients who developed necrotising enterocolitis was 3528 µg/g compared with 390 µg/g without, compared with 1339 µg/g in patients with suspected necrotising enterocolitis (p = 0.0001). Patients with suspected necrotising enterocolitis had a significantly longer length of hospital stay, on average 18 days longer compared to patients without necrotising enterocolitis (p = 0.03). Faecal calprotectin concentrations may reflect severity of gut inflammation in neonates with CHD. Suspected necrotising enterocolitis contributes to longer days nil by mouth and an increase in length of hospital stay.