Independent effects of volume and energy density manipulation on energy intake and appetite in healthy adults: A randomized, controlled, crossover study.

Consuming enough energy to meet high energy demands can be challenging for military personnel wherein logistical constraints limit food availability. Increasing dietary energy density (ED) and/or volume density (VD) of rations may be countermeasures, but whether positive linear associations between ED and energy intake (EI) hold at moderate-to-high ED and VD is unclear. This study examined the effects of covertly increasing the ED and VD of moderate ED (≥1.6 kcal/g) foods on appetite and energy intake. Twenty healthy men completed four 2-day treatments in random order by consuming a standardized diet containing three experimental food items (EXP) engineered using leavening, physical compression and fat manipulation to be isovolumetric but lower (L) or higher (H) in ED and VD creating four treatments: LED/LVD, LED/HVD, HED/LVD, HED/HVD. Consumption of EXP was compulsory during two meals and a snack, but remaining intake was self-selected (SSF). Results failed to show any ED-by-VD interactions. During LVD, EI was lower for EXP (-417 kcal [95%CI: 432, -402], p < 0.01) and TOTAL (SSF + EXP) (-276 kcal [95%CI: 470, -83], p = 0.01) compared to HVD, while SSF EI did not differ (140 kcal [-51, 332], p = 0.15). During LED, EI for EXP (-291 kcal [95%CI: 306, -276], p < 0.01) was lower than HED, while SSF EI was higher than HED (203 kcal 95%CI: [12, 394], p = 0.04) and TOTAL EI did not differ (-88 kcal [-282, 105], p = 0.36). Thus, when a small isovolumetric portion of the diet was manipulated, increasing the VD of moderate ED foods failed to elicit compensatory reductions in ad libitum EI while increasing the ED of moderate ED foods did. Findings may support VD manipulation of moderate ED foods as a strategy to promote increased short-term EI in environments wherein logistical burden may limit food volume.

Glycaemic regulation, appetite and ex vivo oxidative stress in young adults following consumption of high-carbohydrate cereal bars fortified with polyphenol-rich berries.

Consumption of certain berries appears to slow postprandial glucose absorption, attributable to polyphenols, which may benefit exercise and cognition, reduce appetite and/or oxidative stress. This randomised, crossover, placebo-controlled study determined whether polyphenol-rich fruits added to carbohydrate-based foods produce a dose-dependent moderation of postprandial glycaemic, glucoregulatory hormone, appetite and ex vivo oxidative stress responses. Twenty participants (eighteen males/two females; 24 (sd 5) years; BMI: 27 (sd 3) kg/m2) consumed one of five cereal bars (approximately 88 % carbohydrate) containing no fruit ingredients (reference), freeze-dried black raspberries (10 or 20 % total weight; LOW-Rasp and HIGH-Rasp, respectively) and cranberry extract (0·5 or 1 % total weight; LOW-Cran and HIGH-Cran), on trials separated by ≥5 d. Postprandial peak/nadir from baseline (Δmax) and incremental postprandial AUC over 60 and 180 min for glucose and other biochemistries were measured to examine the dose-dependent effects. Glucose AUC0-180 min trended towards being higher (43 %) after HIGH-Rasp v. LOW-Rasp (P=0·06), with no glucose differences between the raspberry and reference bars. Relative to reference, HIGH-Rasp resulted in a 17 % lower Δmax insulin, 3 % lower C-peptide (AUC0-60 min and 3 % lower glucose-dependent insulinotropic polypeptide (AUC0-180 min) P<0·05. No treatment effects were observed for the cranberry bars regarding glucose and glucoregulatory hormones, nor were there any treatment effects for either berry type regarding ex vivo oxidation, appetite-mediating hormones or appetite. Fortification with freeze-dried black raspberries (approximately 25 g, containing 1·2 g of polyphenols) seems to slightly improve the glucoregulatory hormone and glycaemic responses to a high-carbohydrate food item in young adults but did not affect appetite or oxidative stress responses at doses or with methods studied herein.

Mapping the literature of hospital pharmacy.

OBJECTIVES: This study describes the literature of hospital pharmacy and identifies the journals most commonly cited by authors in the field, the publication types most frequently cited, the age of citations, and the indexing access to core journals. The study also looks at differing citation practices between journals with a wide audience compared to a national journal with a focus on regional issues and trends in the field. METHOD: Cited references from five discipline-specific source journals were collected and analyzed for publication type and age. Two sets were created for comparison. Bradford's Law of Scattering was applied to both sets to determine the most frequently cited journals. RESULTS: Three-quarters of all cited items were published within the last 10 years (71%), and journal articles were the most heavily cited publication type (n=65,760, 87%). Citation analysis revealed 26 journal titles in Zone 1, 177 journal titles in Zone 2, and the remaining were scattered across 3,886 titles. Analysis of a national journal revealed Zone 1 comprised 9 titles. Comparison of the 2 sets revealed that Zone 1 titles overlapped, with the exception of 2 titles that were geographically focused in the national title. CONCLUSION: Hospital pharmacy literature draws heavily from its own discipline-specific sources but equally from core general and specialty medical journals. Indexing of cited journals is complete in PubMed and EMBASE but lacking in International Pharmaceutical Abstracts. Gray literature is a significant information source in the field.

Comparing the multivariate relationships of conceptual adversity models and structural brain development in adolescent girls: A registered report.

Adverse experiences throughout development confer risk for a multitude of negative long-term outcomes, but the processes via which these experiences are neurobiologically embedded are still unclear. Adolescence provides an opportunity to understand how these experiences impact the brain's rapidly changing structure. Two models are central to current adversity conceptualizations: a cumulative risk model, where all types of experiences are combined to represent accumulating stress, and a dimensional model, where certain features of experience (e.g., threat or deprivation) exert unique neurophysiological influence. In this registered report, we extended upon previous research by using a form of representational similarity analysis to examine whether the dimensional and cumulative risk models of adversity predict cortical thinning in frontoparietal and frontotemporal networks and volumetric changes in subcortical regions throughout adolescence. Drawing from a longitudinal sample of 179 adolescent girls (ages 10-13 years at the first wave) from Lane County, Oregon, United States, and up to four waves of follow-up data, we found that operationalizing adversity by similarity in threat and deprivation provided better prediction of brain development than similarity in overall adversity. However, these dimensions do not exhibit unique associations with developmental changes in the hypothesized brain changes. These results underscore the significance of carefully defining adversity and considering its impact on the entire brain. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Revisioning aging: Indigenous, crip and queer renderings.

In this article, we re-vision Anishinaabe, crip and queer futures of aging against and beyond dominant successful aging narratives by drawing on our archive of digital/multimedia videos (short documentaries) produced in conjunction with older/e/Elder persons and the Re•Vision: Centre for Art and Social Justice. These documentaries are directed and come from the lives of those older and e/Elder persons whose aging embodiments intra-sect with their Indigenous, disabled and queer selves. Disrupting hegemonic successful aging narratives, and specifically heteronormative and ableist trajectories of aging, these alternative renderings of aging futures offer rich, affective relationalities and cyclical timescapes of older experience that draw on the past even as they reach into divergent futurities. Anishinaabe, crip and queer aging emerge. While we discern resonances in relationalities and temporalities among and between the Anishinaabe and non-Indigenous stories, we also identify significant differences across accounts, indicating that they cannot be collapsed together. Instead, we argue for holding different life-ways and futures alongside one another, following the 1613 Two Row Wampum Treaty between the Dutch and the Haudenosaunee, in which each party promised to respect the other's ways, and committed to non-interference, as well as to the development and maintenance of relationship.

Multimethod assessment of pubertal timing and associations with internalizing psychopathology in early adolescent girls.

Early pubertal timing has consistently been associated with internalizing psychopathology in adolescent girls. Here, we aimed to examine whether the association between timing and mental health outcomes varies by measurement of pubertal timing and internalizing psychopathology, differs between adrenarcheal and gonadarcheal processes, and is stronger concurrently or prospectively. We assessed 174 female adolescents (age 10.0-13.0 at Time 1) twice, with an 18-month interval. Participants provided self-reported assessments of depression/anxiety symptoms and pubertal development, subjective pubertal timing, and date of menarche. Their parents/guardians also reported on the adolescent's pubertal development and subjective pubertal timing. We assessed salivary dehydroepiandrosterone (DHEA), testosterone, and estradiol levels and conducted clinical interviews to determine the presence of case level internalizing disorders. From these data, we computed 11 measures of pubertal timing at both time points, as well as seven measures of internalizing psychopathology, and entered these in a Specification Curve Analysis. Overall, earlier pubertal timing was associated with increased internalizing psychopathology. Associations were stronger prospectively than concurrently, suggesting that timing of early pubertal processes might be especially important for later risk of mental illness. Associations were strongest when pubertal timing was based on the Tanner Stage Line Drawings and when the outcome was case-level Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) depression or Hierarchical Taxonomy of Psychopathology (HiTOP) distress disorders. Timing based on hormone levels was not associated with internalizing psychopathology, suggesting that psychosocial mechanisms, captured by timing measures of visible physical characteristics might be more meaningful determinants of internalizing psychopathology than biological ones in adolescent girls. Future research should precisely examine these psychosocial mechanisms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Value of Mechanistic Experiments to Target the Shared Neural Circuitry of Parenting and Addiction: The Potential for Video Feedback Interventions.

Certain neural processes that underlie addiction are also central to parenting, notably stress and reward. Parenting interventions that incorporate the unique context of caregivers with addiction have demonstrated some success: However, real-world implementation of evidence-based interventions can be difficult with this population. Video feedback interventions are an especially promising approach to reach parents who experience barriers to participation, particularly caregivers with addiction. A translational neuroscientific approach to elucidating the mechanisms of change in these interventions will aid the delivery and success of this method and advance theory surrounding parenting in the context of addiction. Along these lines, we provide an example of one video feedback intervention, Filming Interactions to Nurture Development, that will serve as such a mechanistic experiment.

Ultrasonic agglomeration of model flour systems: Process parameter-product physico-thermal property relationships.

Ultrasonic compression was applied to wheat flour to create an agglomerated and compacted model food system. This novel process combines physical compression with ultrasonic vibration to permanently weld particles together, thereby producing a robust compact. Fundamental relationships among operating parameters, energy imparted to the specimens, and physical properties of the agglomerated products were developed. Integrated agglomeration energy was determined to be a linear function of percent maximum horn amplitude and ultrasonication time, and integrated energy in turn influenced product physical properties, such as density and fracture strength, in highly significant linear relationships. Microscopic, computer tomographic, and differential scanning calorimetric analyses confirmed progressive compaction of and thermal stability changes in the flour matrix with increased processing energy. Specimens agglomerated at higher energy levels were furthermore demonstrated to have higher fracture strength than conventionally (pressure-only) compressed specimens despite similar densities, due to the robust interparticle bridging produced by agglomeration. PRACTICAL APPLICATION: Ultrasonic agglomeration represents a potential improvement over standard compression in the manufacturing of meal-supplementing energy bars. Ultrasonic agglomeration effectively adheres particles together without incorporation of low-nutrient- density syrups and binders. Agglomerated and compacted products also have superior mechanical stability, which can improve texture and physical stability during product handling.

How medical students demonstrate their professionalism when reflecting on experience.

OBJECTIVES: This paper aims to examine the discourses used by students in a formal assessment of their ability to demonstrate professional values when reflecting on their experiences. METHODS: We carried out a discourse analysis of 50 randomly selected essays from a summative assessment undertaken by all five year groups of students in one UK medical school. RESULTS: Students were able to identify a wealth of relevant examples and to articulate key principles of professional practice. They were also able to critique behaviours and draw appropriate conclusions for their own intended professional development. Detailed textual analysis provided linguistic clues to the depth of apparent reflection: recurrent use of rhetorical language with minimal use of first-person reflections, lack of analysis of underlying factors, and simplistic views of solutions may all indicate students whose ability to learn by reflection on experience needs further development. There were also areas in which cohorts as a whole appeared to have a limited grasp of the important professional issues being addressed. CONCLUSIONS: Assessing written reflections is a useful way of making students link their experiences with professional development. The detailed analysis of language usage may help to refine marking criteria, and to detect students and course components where reflective learning competencies are not being achieved.

Lessons learned from a lateral violence and team-building intervention.

BACKGROUND: Lateral violence is likely to exist in settings characterized by poor leadership and lack of clearly articulated roles, expectations, and processes that guide behavior. OBJECTIVES: The purposes of this process improvement project were to (1) identify and improve baseline levels of nurse satisfaction and group cohesion through planned unit-based interventions, (2) determine the effect of a team-building intervention on factors that impact cohesive team functioning, and (3) determine the effect of lateral violence training and communication style differences in improving team cohesion. METHODS: The sample consisted of registered nurses (RNs) from 4 diverse patient care areas, chosen on the basis of low scores on the National Database of Nursing Quality Indicators (NDNQI) RN-RN interaction subscale. A quasi-experimental pre-post intervention design without a control group was employed. The intervention focused on lateral violence and team building. A qualitative component focused on the impact of the intervention on overall group dynamics and processes. RESULTS: RN scores on the Group Cohesion Scale (P = .037) and the RN-RN interaction scores improved postintervention. Group sessions focused on building trust, identifying and clarifying roles, engaging staff in decision making, role-modeling positive interactions, and holding each other accountable. CONCLUSIONS: Key to a cohesive environment is an effective nurse manager able to drive and sustain change.

Optimal transplant education for recipients to increase pursuit of living donation.

CONTEXT: Inadequate transplant education may stop kidney patients from beginning or completing evaluation or limit recipients from considering living donation. OBJECTIVE: To learn about recipients' decision making about living donation and preferred transplant education resources. DESIGN: Retrospective, cross-sectional survey. PATIENTS: 304 kidney recipients. MAIN OUTCOME MEASURES: Living donation comfort, concerns, education preferences. RESULTS: Recipients spent 10 median hours learning about transplant, primarily by speaking to medical staff (2-3 hours) and reading transplant brochures (0-1 hour). Twelve percent had not received any education before coming to the transplant center. At least 75% wanted education discussing the evaluation, surgery, and medical tests required of recipients and donors, as well as common transplant-related fears. Recipients who received living donor transplants were more interested in information about donors' evaluation (P < .001), surgery (P < .001), medical tests (P < .001), and donation concerns (P = .004) than were other recipients. Recipients who had living donors evaluated were more comfortable accepting family members or friends who volunteered rather than asking potential donors because of concerns about pressuring donors (85%), harming their health (83%), or causing them pain or inconvenience (76%). Besides providing accurate medical information, education that addresses recipients' fears about transplantation, explains living donors' donation experiences, and teaches patients how to pursue living donation may increase recipients' pursuit of living donation.

Long-Term Vitamin Stabilization in Low Moisture Products for NASA: Techniques and Three-Year Vitamin Retention, Sensory, and Texture Results.

Multiyear spaceflight will require innovative strategies to preserve vitamins in foods, in order to retain astronaut health and functionality long-term. Furthermore, space foods must be low weight/volume to comply with cargo restrictions, and must retain sensory quality to ensure consumption. Low water activity products were developed, fortified with vitamins A, B1, B9, C, and E at twice their spaceflight requirements, stored for three years at 21 °C and one year at 38 °C, and analyzed annually for retained vitamin content and organoleptic quality. The vitamins were encapsulated in carbohydrate or lipid coatings and tested in relatively low and high fat versions of compressed bars and powdered drink mix formulations. Susceptibility to degradation at 21 °C followed the sequence B9 > A > B1 > C > E; degradation rates were fitted to first-order kinetics. Vitamins A and C were more sensitive at the higher storage temperature. Vitamin retention was slightly higher in compressed bars verses powders. Effects of matrix lipid level on stability were vitamin dependent. Sensory characteristics for products stored three years at 21 °C remained mostly above 6.0 on a 9-point hedonic scale, whereas those stored for one year at 38 °C remained mostly above 5.0. Compressed bars firmed significantly during storage. All vitamin levels after three years at 21 °C remained above the space flight requirements, demonstrating the suitability of the selected fortification schemes and food matrices for long-term preservation. PRACTICAL APPLICATION: Vitamins A, B1, B9, C, and E were retained at 70% to 95% levels for three years at 21 °C in carefully formulated, fortified low water activity products. Product compression and vacuum packaging slightly helped to further preserve vitamins. The sensory quality of these products was retained throughout storage.

Optimization of follow-up timing from study of patterns of first failure after primary treatment. An example from patients with NSCLC: a study of the REACT working group of ESTRO.

BACKGROUND AND PURPOSE: The European Society for Therapeutic Radiology and Oncology was funded by the EU for a project on Recording providing Education, and Ameliorating the Consequences of Treatment (REACT). An important aim of follow-up (FU) after treatment for cancer is to detect various events associated with disease recurrence or metastatic spread or severe treatment-related complications as early as possible. Each tumour type may show a specific pattern and timing of these events related to different prognostic factors. The aim of this study was to propose a way of defining an optimal timing schedule for follow-up after treatment based on the analysis of failure patterns determined from follow-up data from prospective clinical trials. MATERIAL AND METHODS: Cox proportional hazards model was used to identify prognostic factors associated with each failure type (loco-regional recurrence (LR), distant metastasis (DM) or side effects (SE)). Competing risks methods were applied to estimate the cumulative incidence functions (CIF), adjusted on the significant prognostic factors. Equally spaced quantiles of the CIF were then used to estimate the corresponding optimised follow-up times depending on a pre-specified total number of visits. Follow-up data from the CHART bronchus clinical trial were used to analyse the pattern of time to first failure. RESULTS: A significantly higher risk of failure was observed for males (SE), stage III (DM) and conventional treatment (LR). Overall, patients treated with CHART needed 1 fewer visit in each category of patients compared to the Conventional group. For example, stage III male patients treated with CHART would need 8 visits during the first two years at 7, 11, 16, 24, 37, 52, 64 and 104 weeks rather than the 9 follow-up visits planned in the protocol. Similar patients treated with Conventional radiotherapy would need 8 visits at 3, 5, 7, 11, 15, 24, 52 and 104 weeks. CONCLUSIONS: Use of these methods would allow timing of follow-up visits to be adapted according to tumour site and prognostic factors determined previously from audit or clinical trials. Application of this approach could optimize the timing of follow-up visits by placing them closer to the times when failures are expected to occur. It does not address the wider issues of follow-up such as who should do it or what should be done for which further studies are required.

The Inhibition of Maillard Browning by Different Concentrations of Rosmarinic Acid and Epigallocatechin-3-Gallate in Model, Bakery, and Fruit Systems.

UNLABELLED: Rosmarinic acid and Epigallocatechin gallate concentrations were studied as natural inhibitors of Maillard browning in glucose/glycine model systems, and in bakery rolls and applesauce. The concentrations of the inhibitors were varied to determine the highest level of inhibition without a pro-oxidant/browning effect. UV absorbance and gas chromatography/mass spec (GC/MS) with solid phase microextraction (SPME) sampling was used to study browning in the model systems. Hunter L*, a*, b* was used to analyze the color change results of the inhibitors on applesauce and bakery rolls. It was determined that a 1.0% solution of either antioxidant in the glucose/glycine system produced the greatest inhibition and a synergistic effect was not apparent when the two were combined. Inhibition of browning and a lack of synergy between the antioxidants were also determined in food systems consisting of applesauce and bakery rolls. GC/MS analysis of the model system revealed a high level of pyrazine formation in no-inhibitor control samples and the absence of pyrazines in inhibitor-containing samples. PRACTICAL APPLICATION: Natural browning inhibitors, that is Rosmarinic acid and Epigallocatechin gallate, can be added to food items to inhibit browning over a prolonged period of storage in order to increase product shelf stability. The concentrations of the inhibitors require optimization since a pro-oxidant effect and increased browning will occur at high levels.

Absorption of omega-3 fats from carbohydrate and proteinaceous food matrices before and after storage.

Development of n-3 fortified, shelf-stable foods is facilitated by encapsulated docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), since natural n-3 food sources cannot withstand high temperature and prolonged shelf life. Organoleptic stability of n-3 fortified, shelf-stable foods has been demonstrated, but chemical changes in the food matrix throughout storage could conceivably impact digestibility of the protein-based encapsulant thereby compromising n-3 bioavailability. We assessed the effect of prolonged high-temperature storage and variations in food matrix (proteinaceous or carbohydrate) on the time course and magnitude of blood fatty acids changes associated with ingestion of n-3 fortified foods. Low-protein (i.e., cake) and high-protein (i.e., meat sticks) items were supplemented with 600 mg encapsulated DHA+EPA, and frozen either immediately after production (FRESH) or after 6 months storage at 100°F (STORED). Fourteen volunteers consumed one item per week (randomized) for 4 weeks. Blood samples obtained at baseline, 2, 4, and 6 h post-consumption were analyzed for circulating long-chain omega 3 fatty acids (LCn3). There was no difference in LCn3 area under the curve between items. LCn3 in response to cakes peaked at 2-h (FRESH: 54.0 ± 16.8 µg/mL, +18%; STORED: 53.0 ± 13.2 µg/mL, +20%), while meats peaked at 4-h (FRESH: 51.9 ± 12.5 µg/mL, +22%; STORED: 53.2 ± 16.9 µg/mL, +18%). There were no appreciable differences in time course or magnitude of n-3 appearance in response to storage conditions for either food types. Thus, bioavailability of encapsulated DHA/EPA, within low- and high-protein food items, was not affected by high-temperature shelf-storage. A shelf-stable, low- or high-protein food item with encapsulated DHA/EPA is suitable for use in shelf-stable foods.

Correction: evaluating predictive pharmacogenetic signatures of adverse events in colorectal cancer patients treated with fluoropyrimidines.

[This corrects the article DOI: 10.1371/journal.pone.0078053.].

Dorothy Reed and Hodgkin's disease: a reflection after a century.

It has now been 100 years since Dorothy Reed, at the age of 28, wrote her paper on Hodgkin's disease. Her biography reveals the difficult lives of women entering the hitherto male-dominated field of medicine, let alone medical research. Her historic paper on Hodgkin's disease is remarkable for its brilliant observations and concise scientific reasoning. Nevertheless, she was told that as a woman she could not hope for a career as an academic pathologist. After marriage to Charles Elwood Mendenhall, Professor of Physics at the University of Wisconsin and after giving birth to four children, the second part of her career began. Motivated by the loss of her firstborn, she began a study of infant mortality, an interest that lasted throughout her career. In 1926, Mendenhall undertook a survey comparing infant and maternal mortality rates in Denmark and the United States. This influential study concluded that American mortality rates were higher because of unnecessary interference in the natural process of childbirth and recommended the education of midwives follow the Danish model. In 1937, her efforts were rewarded when Madison, WI received recognition for having the lowest infant mortality of any city in the United States. Reading Reed's paper on Hodgkin's disease, we see that her observations go far beyond a description of a specific cell. Her presentation of macroscopic and microscopic features is remarkable for the distinction between "young" and "old" growths: Reed saw Hodgkin's disease as a process, rather than the spreading of a cancer. She was the first to note that those most commonly affected are boys or young adults, especially those whose general health before the disease had been excellent. She was also the first to note anergy to tuberculin. Dorothy Reed defined Hodgkin's disease in relation to tuberculosis, described its pathologic features, and offered comments on its pathogenesis, epidemiology, and immunology that still deserve to be discussed.

Audit of effectiveness of routine follow-up clinics after radiotherapy for cancer: a report of the REACT working group of ESTRO.

BACKGROUND AND PURPOSE: The European Society for Therapeutic Radiology and Oncology was funded by the EU for a project on recording providing education, and ameliorating the consequences of treatment (REACT). An European audit was carried out as part of which to assess the usefulness of current follow-up practices. PATIENTS AND METHODS: Over a 4-month period in 15 cancer centres in 10 countries, patients attending for routine follow-up completed a questionnaire covering their expectations of and satisfaction with the visit. This was matched with a questionnaire completed by the physician about the content and usefulness of the consultation. The feasibility of a short toxicity scale developed by Dische and Saunders was also investigated. RESULTS: In total, 2303 matched questionnaires were analysed. Forty percent of the patients had symptoms or medical problems related to their disease. In 18% there was a positive finding on clinical examination. In 28% investigations were undertaken part of departmental routine practice. Ten percent of the investigations showed an abnormal result. Ninety nine percent of physicians and 85% of the patients expressed satisfaction. Using the short toxicity scale rates of recording toxicity could be increased from 28 to 93%. CONCLUSIONS: There is wide variation in follow-up practices among European centres. There was a low incidence of positive findings clinically or with routine investigations. A simple scale for recording morbidity has proved easy to use by departments, which have not routinely used one of the standard measures. Further work will attempt to produce an European guideline for effective routine follow-up after radiotherapy.

Does writing a list help cancer patients ask relevant questions?

We examined the use of written lists to give patients an opportunity to have their questions answered. Patients undergoing radical radiotherapy for cancer were given a sheet of paper with the simple prompt to write questions and give to the hospital doctor at their appointment 3 weeks later. At 3 months, patients were asked about their use and opinions of the written list. About half of the 478 patients attended with a written list. Fewer patients living in deprived areas used the list compared to more affluent areas. Doctors thought that 34% of patients would not otherwise have asked those questions and 91% of prompted discussions were a worthwhile use of time.

Inhibition of α-amylase and glucoamylase by tannins extracted from cocoa, pomegranates, cranberries, and grapes.

Proanthocyanidins and ellagitannins, referred to as "tannins", exist in many plant sources. These compounds interact with proteins due to their numerous hydroxyl groups, which are suitable for hydrophobic associations. It was hypothesized that tannins could bind to the digestive enzymes α-amylase and glucoamylase, thereby inhibiting starch hydrolysis. Slowed starch digestion can theoretically increase satiety by modulating glucose "spiking" and depletion that occurs after carbohydrate-rich meals. Tannins were isolated from extracts of pomegranate, cranberry, grape, and cocoa and these isolates tested for effectiveness to inhibit the activity of α-amylase and glucoamylase in vitro. The compositions of the isolates were confirmed by NMR and LC/MS analysis, and tannin-protein interactions were investigated using relevant enzyme assays and differential scanning calorimetry (DSC). The results demonstrated inhibition of each enzyme by each tannin, but with variation in magnitude. In general, larger and more complex tannins, such as those in pomegranate and cranberry, more effectively inhibited the enzymes than did less polymerized cocoa tannins. Interaction of the tannins with the enzymes was confirmed through calorimetric measurements of changes in enzyme thermal stability.