The Coaching for Cognition in Alzheimer's (COCOA) trial: Study design.

Comprehensive treatment of Alzheimer's disease (AD) requires not only pharmacologic treatment but also management of existing medical conditions and lifestyle modifications including diet, cognitive training, and exercise. We present the design and methodology for the Coaching for Cognition in Alzheimer's (COCOA) trial. AD and other dementias result from the interplay of multiple interacting dysfunctional biological systems. Monotherapies have had limited success. More interventional studies are needed to test the effectiveness of multimodal multi-domain therapies for dementia prevention and treatment. Multimodal therapies use multiple interventions to address multiple systemic causes and potentiators of cognitive decline and functional loss; they can be personalized, as different sets of etiologies and systems responsive to therapy may be present in different individuals. COCOA is designed to test the hypothesis that coached multimodal interventions beneficially alter the trajectory of cognitive decline for individuals on the spectrum of AD and related dementias (ADRD). COCOA is a two-arm prospective randomized controlled trial (RCT). COCOA collects psychometric, clinical, lifestyle, genomic, proteomic, metabolomic, and microbiome data at multiple timepoints across 2 years for each participant. These data enable systems biology analyses. One arm receives standard of care and generic healthy aging recommendations. The other arm receives standard of care and personalized data-driven remote coaching. The primary outcome measure is the Memory Performance Index (MPI), a measure of cognition. The MPI is a summary statistic of the MCI Screen (MCIS). Secondary outcome measures include the Functional Assessment Staging Test (FAST), a measure of function. COCOA began enrollment in January 2018. We hypothesize that multimodal interventions will ameliorate cognitive decline and that data-driven health coaching will increase compliance, assist in personalizing multimodal interventions, and improve outcomes for patients, particularly for those in the early stages of the AD spectrum. Highlights: The Coaching for Cognition in Alzheimer's (COCOA) trial tests personalized multimodal lifestyle interventions for Alzheimer's disease and related dementias.Dense longitudinal molecular data will be useful for future studies.Increased use of Hill's criteria in analyses may advance knowledge generation.Remote coaching may be an effective intervention.Because lifestyle interventions are inexpensive, they may be particularly valuable in reducing global socioeconomic disparities in dementia care.

Revisiting the intensity output of curing lights in private dental offices.

In a survey published in 1994, it was reported that nearly 30% of dental office curing lights had an intensity output (power density) of < 200 mW/cm2. This study was designed to examine the types of curing lights and the adequacy of the intensity output in the same localities after 10 years. A total of 161 curing lights in 65 dental offices located in 2 metropolitan areas in Texas were examined for the following variables: types of light, power density, resin build-up on the tips, and size of the tips. Two new radiometers were used to measure the outputs. The average intensity output for each light was placed in 5 categories ranging from < 150 mW/cm2 to > 500 mW/cm2. Of 161 lights examined, 127 (78.9%) were halogen, 22 (13.6%) were lightemitting diodes (LEDs), and 12 (7.4%) were plasma arc curing (PAC) lights. The intensity outputs (mW/cm2) of all examined lights were placed into 5 groups: (1) < 149 = 1.8% of lights; (2) 150 to 249 = 8.6%; (3) 250 to 349 = 6.2%; (4) 350 to 499 = 18.6%; and (5) >500 = 64.0%. Build-up on the tip was: none (23%), light (49.7%), moderate (12.4%), and heavy (13.7%). A comparison of the results of this study with the 1994 survey report shows an overall improvement in the intensity output in dental offices. LED and PAC lights constituted 21.2% of curing lights in this survey.

Adverse drug reactions to protease inhibitors.

Protease inhibitors are drugs that are commonly used in the therapy of people living with HIV infection. These drugs are commonly used in combination and act by inhibiting viral protease, blocking viral replication. Adverse drug reactions to protease inhibitors include gastrointestinal problems, rash and metabolic disturbances. The metabolic derangements associated with protease inhibitor therapy are the most problematic adverse events associated with therapy, and vary in incidence from drug to drug. These derangements include hyperlipidemia, abnormal fat distribution (lipodystrophy) and impaired glucose tolerance, which is believed to be due to peripheral insulin resistance. Clinicians caring for patients being treated with protease inhibitors must be vigilant for adverse events, notably those involving altered lipid and glucose metabolism.

Bonding to enamel/dentin etched with phosphoric and hydrofluoric acids.

Repairing porcelain intraorally allows clinicians to provide their patients with a conservative means of treating fractured or debonded restorations. This requires, however, the etching of both porcelain and tooth structure with etching solutions. It is thus relevant to understand the effect that different etching procedures have on shear bond strengths of composite resins to both dentin and enamel structures. Based on the results of this investigation, the authors recommend isolation of tooth structures and the etching of porcelain with hydrofluoric acid.

Reasons for opioid use among patients with dependence on prescription opioids: the role of chronic pain.

The number of individuals seeking treatment for prescription opioid dependence has increased dramatically, fostering a need for research on this population. The aim of this study was to examine reasons for prescription opioid use among 653 participants with and without chronic pain, enrolled in the Prescription Opioid Addiction Treatment Study, a randomized controlled trial of treatment for prescription opioid dependence. Participants identified initial and current reasons for opioid use. Participants with chronic pain were more likely to report pain as their primary initial reason for use; avoiding withdrawal was rated as the most important reason for current use in both groups. Participants with chronic pain rated using opioids to cope with physical pain as more important, and using opioids in response to social interactions and craving as less important, than those without chronic pain. Results highlight the importance of physical pain as a reason for opioid use among patients with chronic pain.

Does the time of day or weekday affect screening accuracy? A pilot correlation study with cytotechnologist workload and abnormal rate detection using the ThinPrep Imaging System.

BACKGROUND: Workload is extensively regulated in gynecologic cytology. However, sensitive monitors of excessive workload are not available. METHODS: We measured the variation in abnormal (atypical squamous cells [ASC], low-grade squamous intraepithelial lesion [LSIL], and high-grade squamous intraepithelial lesion [HSIL]) rates for 4 cytotechnologists (CTs) among different days of the week and at different times during the day while they were performing primary screening with the ThinPrep Imaging System. RESULTS: Three of 4 CTs detected significantly less abnormal cases on 1 day of the week than another (1 Monday, 2 Friday). Two of those CTs detected significantly fewer total abnormal cases in the afternoon than in the morning; this was strongly correlated with increased speed in the afternoon and decreased detection of ASC cases. HPV + rates for ASC cases dropped as the abnormal rate dropped. The third CT detected significantly fewer ASC cases in the morning; this was counterbalanced by an increase detection of LSIL cases, suggesting a shift in diagnostic threshold between the AM and PM. The difference in abnormal detection rates between morning and afternoon correlated with a false-negative fraction of 0.96. CONCLUSIONS: There are significant differences in detection rates of abnormal cases between days of the week and the morning and afternoon. Correlating abnormal rates and workload between the morning and afternoon may represent a sensitive way to detect excessive workload. Because individual CTs may have different responses to workload and no overall pattern emerged, data on their workload and performance need to be tracked individually.