Differential plasma protein expression after ingestion of essential amino acid-based dietary supplement verses whey protein in low physical functioning older adults.

In a recent randomized, double-blind, placebo-controlled trial, we were able to demonstrate the superiority of a dietary supplement composed of essential amino acids (EAAs) over whey protein, in older adults with low physical function. In this paper, we describe the comparative plasma protein expression in the same subject groups of EAAs vs whey. The plasma proteomics data was generated using SOMA scan assay. A total of twenty proteins were found to be differentially expressed in both groups with a 1.5-fold change. Notably, five proteins showed a significantly higher fold change expression in the EAA group which included adenylate kinase isoenzyme 1, casein kinase II 2-alpha, Nascent polypeptide-associated complex subunit alpha, peroxiredoxin-1, and peroxiredoxin-6. These five proteins might have played a significant role in providing energy for the improved cardiac and muscle strength of older adults with LPF. On the other hand, fifteen proteins showed slightly lower fold change expression in the EAA group. Some of these 15 proteins regulate metabolism and were found to be associated with inflammation or other comorbidities. Gene Ontology (GO) enrichment analysis showed the association of these proteins with several biological processes. Furthermore, protein-protein interaction network analysis also showed distinct networks between upregulated and downregulated proteins. In conclusion, the important biological roles of the upregulated proteins plus better physical function of participants in the EAAs vs whey group demonstrated that EAAs have the potential to improve muscle strength and physical function in older adults. This study was registered with ClinicalTrials.gov: NCT03424265 "Nutritional interventions in heart failure."

Quality Improvement in Delirium Health Literacy in Older Adult Patients and Their Caregivers Attending a Geriatric Clinic.

Background: Delirium is a common medical condition that is highly prevalent in older adults who are at increased risk for its development with any illness, post-surgery or during hospitalization. The purpose of our study was to evaluate the health literacy of older adult patients and their caregivers about delirium, offer a brief educational intervention, and reevaluate their knowledge post intervention. Materials and Methods: We conducted a quality improvement project, focused on delirium health literacy in older adult patients ≥60 years and their caregivers. Delirium knowledge of participants was evaluated in a pre-education survey after which they were given a delirium education booklet to read. A post-education delirium survey was conducted within 2-3 weeks of the educational intervention. Chi-square test was used to analyze the knowledge base of older adults. Results: The study population consisted of a total of 70 older adults who participated in pre-education (n=35) and post-education (n=35) surveys. Older adult patients and their caregivers had significant knowledge gaps about the potential causes or etiologies, risk factors, symptomatology, and prevention of delirium in the pre-education survey. After the educational intervention, in the post-education survey, there were overall improvements in knowledge base of older adults in differentiating delirium with dementia (43% vs 94%, p<0.01) recognizing signs and symptoms (77% vs 94%, p<0.05), complications (76% vs 100%, p<0.01) and identifying the etiological factors associated with delirium. Conclusion: The quality improvement project demonstrated that older adults and caregivers have significant knowledge deficits about the common condition of delirium. This study also demonstrated that older adults were able to improve their health literacy regarding delirium after the intervention. Appropriate education on delirium for patients and caregivers might help in earlier identification, prevention, and better overall management of delirium.

Daily Consumption of a Specially Formulated Essential Amino Acid-Based Dietary Supplement Improves Physical Performance in Older Adults With Low Physical Functioning.

We have investigated the hypothesis that nutritional supplementation of the diet in low-physical-functioning older individuals with a specially formulated composition based on essential amino acids (EAAs) would improve physical function as compared to supplementation with the same amount of whey protein. A third group of comparable volunteers were given nutrition education but no supplementation of the diet. After 6 weeks of whey protein supplementation (n = 32), there was no effect on the distance walked in 6 minutes, but the distance walked improved significantly from the pre-value after 12 weeks of whey supplementation. EAA consumption (n = 28) significantly improved walking distance at both 6 and 12 weeks. The distance walked at 12 weeks (419.0 ± 25.0 m) was 35.4 m greater than the pre-value of 384.0 ± 23.0 m (p < .001). The increase in distance walked by the EAA group was also significantly greater than that in the whey group at both 6 and 12 weeks (p < .01). In contrast, a decrease in distance walked was observed in the control group (n = 32) (not statistically significant, NS). EAA supplementation also improved grip strength and leg strength, and decreased body weight and fat mass. Plasma low-density lipoprotein concentration was significantly reduced in the EAA group, as well as the concentration of macrophage migration inhibitory factor. There were no adverse responses in any groups, and compliance was greater than 95% in all individuals consuming supplements. We conclude that dietary supplementation with an EAA-based composition may be a beneficial therapy in older individuals with low physical functional capacity. Clinical Trials Registration Number: This study was registered with ClinicalTrials.gov: NCT03424265-"Nutritional interventions in heart failure."

Patient perceptions of professionalism: implications for residency education.

OBJECTIVES The purpose of this study was three-fold: to identify which behavioural, communicative and personal presentation characteristics most closely represent patients' views of professionalism; to determine whether patients perceive resident doctors as displaying these characteristics, and to explore whether or not resident doctor professional behaviour creates an impression of clinical competence to the degree where patients perceive a decreased need for Attending Physician involvement. METHODS We carried out a descriptive, cross-sectional study at an academic centre. An anonymous, voluntary four-question survey with multiple items was administered to all adult patients or the parents of paediatric patients attending an ophthalmology clinic who were seen by a resident doctor followed by an Attending Physician. RESULTS A total of 133 of 148 (90%) surveys were returned. All the itemised characteristics of professionalism were reported to be important or very important to the majority of participants.The most important were: 'Pays attention to my concerns' (90%); 'Is compassionate' (83%), and 'Speaks in terms that I can understand' (83%). Although 85% of respondents reported that resident doctors demonstrated all the characteristics of professionalism listed on the survey, 83% of participants stated that it was important or very important that residents have Attending Physician involvement. CONCLUSIONS Patient-centred components of professionalism, such as communication skills and compassion, are more important to patients than social behaviours, such as appearance and acknowledgement of family members. Resident doctors are perceived to display a high level of professionalism during patient care. Patients clearly desire direct resident doctor

Observed and Modeled Seasonal Air Quality and Respiratory Health in Senegal During 2015 and 2016.

In this work, we use existing particulate matter (PM) data from Dakar, Senegal, satellite aerosol optical depth (AOD) and the Weather Research and Forecasting (WRF) model to evaluate the role of dust transport from the Sahara and PM concentrations and exposure into other administrative districts of Senegal during 2015 and 2016. We also use data from the Ministry of Health to examine spatial and temporal patterns of acute respiratory infections, asthma, bronchitis, and tuberculosis across Senegal with an emphasis on Northern Hemisphere winter December-February, when air quality is poor, and June-August when there is an improvement in air quality. Measurements in Dakar, Senegal, suggest hazardous PM10 concentrations associated with Saharan dust storms but lower PM10 concentrations during the summer. The WRF dust simulations show a similar temporal pattern to the observations in Dakar, Senegal, with notable biases. However, the WRF model suggests that the highest dust concentrations are found across the northern half of Senegal during the winter season where there are no currently PM measurements. Health data during 2015-2016 show the highest prevalence of asthma and bronchitis in Dakar, Senegal, suggesting that other sources of air pollution are important. Acute respiratory infection is prevalent throughout the country with the high prevalence found in rural zones, for children between 12 and 59 months. All measures including real-time monitoring, air quality forecast, and communication should be used to protect the public from potentially hazardous environmental conditions during the winter season.