The sensitivity and specificity of methylene blue dye as a single agent in sentinel lymph node biopsy for early breast cancer.

INTRODUCTION: Axillary lymph node dissection (ALND), although associated with significant morbidity, has been the standard procedure for axillary staging for breast cancer in many hospitals in Malaysia. The limited resources for radioisotope tracer and nuclear medicine service, coupled with insufficient number of trained surgeons, have been the major obstacles to perform sentinel lymph node biopsy (SLNB). MATERIALS AND METHODS: This study looks into the application of 1% methylene blue dye (MBD) as a single agent for SLNB and observes the outcome and any associated complication. Thirty-four patients with early breast cancer were enrolled. Two millilitres (ml) of 1% MBD was diluted with saline to a total volume of 5 ml. After induction of general anaesthesia, 3 ml of the diluted 1% MBD is injected subdermally at the upper outer quadrant of the breast followed by 5 minutes of massage. Sentinel nodes are identified as blue nodes or lymph nodes with a blue-stained lymphatic channel and were surgically removed. All patients then underwent tumour excision, either mastectomy or breast-conserving surgery, and ALND. The sentinel nodes were categorized to positive or negative for metastases and were compared with axillary lymph nodes for diagnostic value assessment. RESULTS: Identification rate of sentinel nodes was 91.2%. The mean number of removed sentinel nodes was 2 (SD=1) and the mean number of axillary nodes was 16 (SD=6). Sentinel node metastasis was found in 13 (41.9%) cases. There were two false-negative cases, resulting in a sensitivity of 86.7% (95%CI: 62.1-96.3). The negative predictive value of sentinel nodes to predict axillary metastasis was 88.9% (95%CI: 67.2- 96.9). There were no complications observed. CONCLUSION: Although inferior to the standard dual-tracer technique, the usage of MBD as a single agent in SLNB for early breast cancer still offers favourable accuracy and identification rate. With continuous training and improved surgeons experience, performing SLNB with blue dye alone is feasible in order to reduce the risks and morbidities associated with ALND.

Evaluation of Attenuated Tumor Antigens and the Implications for Peptide-Based Cancer Vaccine Development.

INTRODUCTION: Peptide vaccines offer anti-tumor efficacy with very low toxicity. However, repeat stimulation with an immunogenic peptide leads to activation induced cell death (AICD), decreasing efficacy. We engineered variants of an immunogenic peptide (E39) and tested their ability to induce a robust, sustainable immune response. METHODS: Multiple variants of E39 were created by exchanging 1 or 2 amino acids. We tested the PBMC proliferation, cytokine production and cytolytic activity induced by each variant peptide. RESULTS: Repeated stimulation with E39 likely led to in vitro AICD, while stimulation with E39' led to T-cell proliferation with less evidence of AICD, modest cytokine production and high CTL activity. CONCLUSIONS: E39' appears to be the optimal variant of E39 for inducing effective long-term immunity.

A genome-wide analysis of the response to inhaled ß2-agonists in chronic obstructive pulmonary disease.

Short-acting ß2-agonist bronchodilators are the most common medications used in treating chronic obstructive pulmonary disease (COPD). Genetic variants determining bronchodilator responsiveness (BDR) in COPD have not been identified. We performed a genome-wide association study (GWAS) of BDR in 5789 current or former smokers with COPD in one African-American and four white populations. BDR was defined as the quantitative spirometric response to inhaled ß2-agonists. We combined results in a meta-analysis. In the meta-analysis, single-nucleotide polymorphisms (SNPs) in the genes KCNK1 (P=2.02 × 10(-7)) and KCNJ2 (P=1.79 × 10(-7)) were the top associations with BDR. Among African Americans, SNPs in CDH13 were significantly associated with BDR (P=5.1 × 10(-9)). A nominal association with CDH13 was identified in a gene-based analysis in all subjects. We identified suggestive association with BDR among COPD subjects for variants near two potassium channel genes (KCNK1 and KCNJ2). SNPs in CDH13 were significantly associated with BDR in African Americans.The Pharmacogenomics Journal advance online publication, 27 October 2015; doi:10.1038/tpj.2015.65.

Interactions between oil substrates and glucose on pure cultures of ruminal lipase-producing bacteria.

The hydrolysis of free fatty acids from lipids is a prerequisite for biohydrogenation, a process that effectively saturates free fatty acids. Anaerovibrio lipolyticus 5s and Butyrivibrio fibrisolvens have long been thought to be the major contributors to ruminal lipolysis; however, Propionibacterium avidum and acnes recently have been identified as contributing lipase activity in the rumen. In order to further characterize the lipase activity of these bacterial populations, each was grown with three different lipid substrates, olive oil, corn oil, and flaxseed oil (3 %). Because different finishing rations contain varying levels of glycogen (a source of free glucose) this study also documented the effects of glucose on lipolysis. P. avidum and A. lipolyticus 5s demonstrated the most rapid rates (P < 0.05) of lipolysis for cultures grown with olive oil and flaxseed oil, respectively. A. lipolyticus, B. fibrisolvens, and P. avidum more effectively hydrolyzed flaxseed oil than olive oil or corn oil, especially in the presence of 0.02 % glucose. Conversely, P. acnes hydrolyzed corn oil more readily than olive oil or flaxseed oil and glucose had no effect on lipolytic rate. Thus, these bacterial species demonstrated different specificities for oil substrates and different sensitivities to glucose.

Glycerol inhibition of ruminal lipolysis in vitro.

Supplemental glycerol inhibits rumen lipolysis, a prerequisite for rumen biohydrogenation, which is responsible for the saturation of dietary fatty acids consumed by ruminant animals. Feeding excess glycerol, however, adversely affects dry matter digestibility. To more clearly define the effect of supplemental glycerol on rumen lipolysis, mixed populations of ruminal bacteria were incubated with 6 or 20% glycerol (vol/vol). After 48-h anaerobic incubation of mixed culture rumen fluid, rates of free fatty acid production (nmol/mL per h) for the 6 and 20% glycerol-supplemented samples were decreased by 80 and 86%, respectively, compared with rates from nonsupplemented control cultures (12.4±1.0; mean ± SE). Conversely, assay of the prominent ruminal lipase-producing bacteria Anaerovibrio lipolyticus 5S, Butyrivibrio fibrisolvens 49, and Propionibacterium species avidum and acnes revealed no effect of 2 or 10% (vol/vol) added glycerol on lipolytic activity by these organisms. Supplementing glycerol at 6% on a vol/vol basis, equivalent to supplementing glycerol at approximately 8 to 15% of diet dry matter, effectively reduced lipolysis. However, the mechanism of glycerol inhibition of ruminal lipolysis remains to be demonstrated.

Survival and germination of Clostridium perfringens spores during heating and cooling of ground pork.

The effect of heating rate on the heat resistance, germination, and outgrowth of Clostridium perfringens spores during cooking of cured ground pork was investigated. Inoculated cured ground pork portions were heated from 20 to 75°C at a rate of 4, 8, or 12°C/h and then held at 75°C for 48 h. No significant differences (P > 0.05) in the heat resistance of C. perfringens spores were observed in cured ground pork heated at 4, 8, or 12°C/h. At heating rates of 8 and 12°C/h, no significant differences in the germination and outgrowth of spores were observed (P > 0.05). However, when pork was heated at 4°C/h, growth of C. perfringens occurred when the temperature of the product was between 44 and 56°C. In another set of experiments, the behavior of C. perfringens spores under temperature abuse conditions was studied in cured and noncured ground pork heated at 4°C/h and then cooled from 54.4 to 7.2°C within 20 h. Temperature abuse during cooling of noncured ground pork resulted in a 2.8-log CFU/g increase in C. perfringens. In cured ground pork, C. perfringens decreased by 1.1 log CFU/g during cooling from 54.4 to 36.3°C and then increased by 0.9 log CFU/g until the product reached 7.2°C. Even when the initial level of C. perfringens spores in cured ground pork was 5 log CFU/g, the final counts after abusive cooling did not exceed 3.4 log CFU/g. These results suggest that there is no risk associated with C. perfringens in cured pork products under the tested conditions.

Evaluation of additional cooking procedures to achieve lethality microbiological performance standards for large, intact meat products.

The U.S. Department of Agriculture Food Safety and Inspection Service (USDA-FSIS) has a specific lethality performance standard for ready-to-eat products. To assist meat processing establishments in meeting the performance standard, USDA-FSIS developed Appendix A, which provides guidelines for cooking temperatures, times, and relative humidity. This project determined whether the USDA-FSIS performance standards for lethality were met when using parameters other than those identified in Appendix A to cook large hams and beef inside rounds. The effects of alternative lethality parameters on the reduction of Salmonella Typhimurium and coliforms and on the toxin production of Staphylococcus aureus were evaluated. Large (9- to 12-kg) cured bone-in hams (n = 80) and large (8- to 13-kg) uncured beef inside rounds (n = 80) were used in this study. The products were subjected to 1 of 10 treatments defined by combinations of final internal product temperatures (48.9, 54.4, 60.0, 65.6, or 71.1°C) and batch oven relative humidities (50 or 90 % ). For all treatments, at least a 6.5-log reduction in Salmonella Typhimurium was achieved. The coliform counts were also substantially reduced for both hams and rounds. Across all treatments for both products, S. aureus toxin production was not detected. The relative humidity did not alter the lethality effectiveness for any of the treatments. The final internal temperatures and relative humidity combinations used in this project achieved the lethality performance standard established by USDA-FSIS for fully cooked, ready-to-eat products.

Measurement and quantification of sessile and planktonic microbial populations during the anaerobic digestion of cellulose.

Crystalline cellulose was anaerobically degraded using a leachate inoculum derived from simulated municipal solid waste. Bicinchoninic Acid (BCA) protein assays were used to measure the distribution of biomass during cellulose degradation, including the planktonic and sessile biomass fractions. A comparison of sessile and planktonic microbial growth indicated that the microbial growth was dominated by the planktonic fraction with the biofilms accounting for approximately 25% of the population. Additional biomass measurements were conducted to test the reliability of the BCA protein assays. Total microbial growth was inferred from the accumulation and depletion of ammonia nitrogen measured using flow injection analysis. The planktonic biomass was estimated from direct cell counts using light microscopy and the sessile biomass was estimated by analysing the nitrogen content of the separated and washed cellulose pellet. Regression analysis showed good correlations between the measurement pairs representing the total biomass (R2=0.90), planktonic biomass (R2=0.97) and sessile biomass (R2=0.85), supporting the use of protein assays as an indicator of microbial growth in mixed culture environments.

Digestion of waste bananas to generate energy in Australia.

This paper presents results from laboratory studies to measure the methane yield and rate of digestion of reject bananas. These parameters were determined in experiments that took into account the likely configuration of a full-scale plant in the banana growing region of north Queensland. The digestion was conducted in a 200-l reactor using fed-batch operation, relying entirely on the natural microbial consortia on the reject bananas to avoid reliance on external inocula such as sludge, an undesirable material around food packaging facilities. An enrichment culture was first established in a highly buffered 200-l batch digestion unit. The fed-batch digester was then started by exchanging leachate with the mature batch reactor. Under loading conditions of 0.6 kg VS m(-3)d(-1) over 70 days where the average working volume was 160 l, the digester produced 398+/-20 l CH4 kg VS(-1). Increasing the loading rate to 1.6 kg VS m(-3)d(-1) resulted in a reduced methane yield of 210 l CH4 kg VS(-1) over 23 days of operation, with a concomitant accumulation of banana waste in the digester. The leachate at the end of digestion contained over 4000 mg l(-1)K, 200 mg l(-1) N and 75 mg l(-1), levels that exceed acceptable limits for general agricultural irrigation.

Development of management policy for the marine ornamental fish and invertebrate fishery in puerto rico: a case study

In recent years the collection of tropical marine organisms for the aquarium trade has become perceived as an activity with an unsustainable history as well as obvious potential for rehabilitation through resource-based fisheries management and consumer-oriented product certification. In the case of Puerto Rico, collection of ornamentals has existed for decades, though unregulated due to a weak fisheries law dating from the 1930's. The new Fisheries Law 278 of 1998 enabled new regulatory approaches for marine ornamentals, which were met with serious challenges rooted in (1) an information gap concerning the fishery regarding participant numbers, collection methods and export volumes, and (2) the absence of consultation of fishers by agency regulators. The information gap led to worst-case assumptions of impact by regulators, and a closure of the fishery, which set the stage for threatening personal confrontations and lawsuits, the latter leading to de facto resource management by judicial order. To redress these issues and move management back into the arena of science and public policy, regulators have initiated a three-phase program: (1) characterize fisher numbers, methods and exports, (2) describe populations and biology of commercial species, and (3) propose appropriate fisheries management approaches. This paper describes only the first phase of this program

Organization and operation of the marine ornamental fish and invertebrate export fishery in Puerto Rico

This fishery was examined utilizing public records, stakeholder interviews, and operational site visits to describe the fishery for the Puerto Rico Coral Reef Advisory Committee as a first step toward development of policies for the effective management of these natural resources. The fishery is not large, including fewer than 20 licensed fishers operating primarily on the west end of the island. Only three operators export product, with the remaining fishers providing specimens to the exporters based upon customer orders. Most collection of coral reef species occurs over hard rubble zones mixed with relic reef structures and rock, or on the sides and frontal areas of active reefs. Other species are collected from among mangrove prop root zones, tidal flats, and seagrass beds. Collections are made using simple barrier and dip nets for fish and motile invertebrates such as shrimp. Invertebrates such as crabs, starfish, and sea cucumbers are commonly collected by overturning small rocks, gathering the specimens, and then replacing the rocks in their original positions. Specimens are carried to the boat and transferred to individual cup holders to maximize survival. Although statements concerning former use of chemicals to assist capture were noted, no evidence of current chemical use was observed. Specimens are held in re-circulating seawater systems onshore until collections are aggregated and shipped. The fishery strives to operate with mortality of<1%, as mortalities of>3% are described as unacceptable to customers. More than 100 fish species are collected in this fishery, but the top ten species account for >70% of the total numbers and >60% of the total value of the fishery, with a single species, Gramma loreto (Royal Gramma), comprising >40% of the numbers. More than 100 species of invertebrates are collected, but this fishery is also dominated by a handful of species, including anemones, hermit crabs, turbo snails, serpent starfish, and feather duster polychaetes

Development of management policy for the marine ornamental fish and invertebrate fishery in puerto rico: a case study.

In recent years the collection of tropical marine organisms for the aquarium trade has become perceived as an activity with an unsustainable history as well as obvious potential for rehabilitation through resource-based fisheries management and consumer-oriented product certification. In the case of Puerto Rico, collection of ornamentals has existed for decades, though unregulated due to a weak fisheries law dating from the 1930's. The new Fisheries Law 278 of 1998 enabled new regulatory approaches for marine ornamentals, which were met with serious challenges rooted in (1) an information gap concerning the fishery regarding participant numbers, collection methods and export volumes, and (2) the absence of consultation of fishers by agency regulators. The information gap led to worst-case assumptions of impact by regulators, and a closure of the fishery, which set the stage for threatening personal confrontations and lawsuits, the latter leading to de facto resource management by judicial order. To redress these issues and move management back into the arena of science and public policy, regulators have initiated a three-phase program: (1) characterize fisher numbers, methods and exports, (2) describe populations and biology of commercial species, and (3) propose appropriate fisheries management approaches. This paper describes only the first phase of this program.

Effects of withdrawal of inhaled steroids in men with severe irreversible airflow obstruction.

Inhaled corticosteroid therapy has proven efficacy for asthmatics, but the benefit for patients with chronic obstructive pulmonary disease (COPD) is less well supported. We hypothesized that withdrawal of inhaled steroids in elderly patients with severe irreversible airway obstruction would not lead to a deterioration in respiratory function. We designed a prospective, double-blind, randomized, placebo-controlled, crossover study to follow spirometry, quality of life questionnaire, six-minute (6-min) walk test, and sputum markers of inflammation during a 6-wk placebo treatment period and a 6-wk treatment period with beclomethasone dipropionate (BDP), 336 microg/d. There were 24 men receiving BDP who entered the study; 15 completed the study. Their mean age was 66.9 +/- 1.9 yr, and mean FEV(1) was 1.61 +/- 0.1 L (47% of predicted). There was a significant decrease in the mean FEV(1 )while using the placebo inhaler (1.70 L versus 1.60 L, baseline versus placebo: 95% CI, 0.002 to 0.195; p < 0.05). There was a decrease in the mean percentage change in FEV(1) for the study subjects during the placebo treatment period as compared with the BDP treatment period (-6.28 versus 5.03%, placebo versus BDP: 95% CI, -23.38 to 0.76; p = 0.06). Six-minute walk test results and sputum analysis for cell count and differential were not significantly different during placebo and BDP treatment periods. Borg scale assessment of dyspnea after exercise was increased while using the placebo inhaler as compared with baseline, and decreased during the BDP treatment period. Chronic Respiratory Disease Questionnaire (CRQ) scores revealed no significant difference between placebo and BDP. This study has demonstrated that in elderly patients with severe irreversible airway obstruction, withdrawal of inhaled corticosteroid therapy leads to a deterioration in ventilatory function and increased exercise-induced dyspnea.

Residence time distributions of gas flowing through rotating drum bioreactors.

Residence time distribution studies of gas through a rotating drum bioreactor for solid-state fermentation were performed using carbon monoxide as a tracer gas. The exit concentration as a function of time differed considerably from profiles expected for plug flow, plug flow with axial dispersion, and continuous stirred tank reactor (CSTR) models. The data were then fitted by least-squares analysis to mathematical models describing a central plug flow region surrounded by either one dead region (a three-parameter model) or two dead regions (a five-parameter model). Model parameters were the dispersion coefficient in the central plug flow region, the volumes of the dead regions, and the exchange rates between the different regions. The superficial velocity of the gas through the reactor has a large effect on parameter values. Increased superficial velocity tends to decrease dead region volumes, interregion transfer rates, and axial dispersion. The significant deviation from CSTR, plug flow, and plug flow with axial dispersion of the residence time distribution of gas within small-scale reactors can lead to underestimation of the calculation of mass and heat transfer coefficients and hence has implications for reactor design and scale-up.

Drugs used for cognitive symptoms of Alzheimer's disease.

AD is a devastating disease that is increasing in real numbers as our population ages. The toll on individuals, families, health care, and society will continue to escalate unless more effective treatment approaches are developed. To date, the most effective treatments are those that increase brain ACh levels by retarding the enzymatic breakdown of this neurotransmitter. These agents have proved modestly effective but are far from being the answer to AD. Further, when these drugs are withdrawn, patients rapidly decompensate to the state of disability suffered by those receiving placebo, indicating the deteriorative process continues unabated. The long-term effects on cognition of these drugs also is not known, but most clinicians are not overly optimistic. Other pharmacologic approaches include vitamin E, ginkgo biloba, estrogen, and the nonsteroidal anti-inflammatory drugs. Clinical trials do not robustly support their efficacy at this time, but there are numerous anecdotal reports to promote any or all of these approaches. Newer strategies under study include antiamyloid agents and nootropics (which enhance neuronal metabolic activity). The value of these approaches remains to be confirmed.

Use of telemedicine for children with special health care needs.

OBJECTIVE: In 1995, the Children's Medical Services (CMS) of the State of Georgia contracted with the Department of Pediatrics of the Medical College of Georgia (MCG) and the MCG Telemedicine Center to develop telemedicine programs to provide subspecialty care for children with special health care needs. This article presents project statistics and results of client evaluation of services, as well as physician faculty attitudes toward telemedicine. DESIGN: A demonstration project using telemedicine between a tertiary center and a rural clinic serving children with special health care needs was established. Data were collected and analyzed for December 12, 1995 to May 31, 1997, during which 333 CMS telemedicine consultations were performed. RESULTS: Most CMS telemedicine consultations (35%) involved pediatric allergy/immunology. Other subspecialties included pulmonology (29%), neurology (19%), and genetics (16%). Overall, patients were satisfied with the services received. Initially, physician faculty members were generally positive but conservative in their attitudes toward using telemedicine for delivering clinical consultation. After a year's exposure and/or experience with telemedicine, 28% were more positive, 66% were the same, and only 4% were more negative about telemedicine. The more physicians used telemedicine, the more positive they were about it (r =.30). CONCLUSIONS: In terms of family attitudes and individual care, telemedicine is an acceptable means of delivering specific pediatric subspecialty consultation services to children with special health care needs, living in rural areas distant to tertiary centers. Telemedicine is more likely to be successful as part of an integrated health services delivery than when it is the sole mode used for delivery of care.

Approach to designing rotating drum bioreactors for solid-state fermentation on the basis of dimensionless design factors.

The development of large-scale solid-state fermentation (SSF) processes is hampered by the lack of simple tools for the design of SSF bioreactors. The use of semifundamental mathematical models to design and operate SSF bioreactors can be complex. In this work, dimensionless design factors are used to predict the effects of scale and of operational variables on the performance of rotating drum bioreactors. The dimensionless design factor (DDF) is a ratio of the rate of heat generation to the rate of heat removal at the time of peak heat production. It can be used to predict maximum temperatures reached within the substrate bed for given operational variables. Alternatively, given the maximum temperature that can be tolerated during the fermentation, it can be used to explore the combinations of operating variables that prevent that temperature from being exceeded. Comparison of the predictions of the DDF approach with literature data for operation of rotating drums suggests that the DDF is a useful tool. The DDF approach was used to explore the consequences of three scale-up strategies on the required air flow rates and maximum temperatures achieved in the substrate bed as the bioreactor size was increased on the basis of geometric similarity. The first of these strategies was to maintain the superficial flow rate of the process air through the drum constant. The second was to maintain the ratio of volumes of air per volume of bioreactor constant. The third strategy was to adjust the air flow rate with increase in scale in such a manner as to maintain constant the maximum temperature attained in the substrate bed during the fermentation.

What is the Word at Logos College? Homosocial ritual or homosexual denial in Don Delillo's End Zone?

"What Is the Word at Logos College? Homosocial Ritual or Homosexual Denial in Don Delillo's End Zone?" investigates the homoerotic desire that, despite being culturally repressed, periodically surfaces in foothall. Given the highly closeted nature of American foothall, it is necessary to look at the puns, allusions, and interactions between the players to see how Don DeLillo has created a text that subtly exposes the homoerotics of male sport. In order to strengthen the connection between homoeroticism and football, I will show how football's invention and organization in America coincides with the construction of the homosexual subject. Football and other arenas for male-male play become enforced at the same time as desire begins to express itself; thus, football is the logical place in America to look for unresolved (and resolved) male homosexuality, and DeLillo does this skillfully.

Ethnic disparities in patient recall of physician recommendations of diagnostic and treatment procedures for coronary disease.

Despite the proven benefits of many cardiac procedures, some are used less frequently for African Americans than for white patients with known or suspected coronary disease. This study explored differences between ethnic groups that may affect patient recall of physician recommendations of cardiac procedures. Also examined were patients' responses when asked about adhering to those recommendations. The data examined were collected from interviews with 1,333 African American and white hospital inpatients with known coronary disease admitted to the Birmingham-Black Health Seeking for Coronary Heart Disease Project (1989-1990) in Alabama. Respondents were asked to recall previous health care encounters, physician recommendations of cardiac procedures, and adherence to those recommendations. Compared with whites, fewer African American patients recalled physicians recommending some cardiac procedures. If procedure recommendations were recalled, no ethnic differences were found in patient recall of adhering to those recommendations. Predictors of recall of the recommended procedures were identified by multivariate logistic regression. Patients' knowledge of having coronary disease was the common factor that predicted their recall of all cardiac procedures. Other predictor variables included some cardiac risk factors and symptoms, socioeconomic status, and ethnicity. Although health care practice is influenced by many factors, it is important to examine variables that may lead to a reduction in ethnic disparities in coronary disease morbidity and mortality.

Nutritional status of urban homebound older adults.

The purposes of this study were to assess comprehensively the nutritional status of frail older adults living in an urban area and to identify factors associated with nutritional insufficiency. Subjects were 49 adults aged > or = 65 y followed by the Jefferson County Home Health Department. Twenty-nine percent of the women and 63% of the men had a body mass index (BMI; in kg/m2) < 24. Nineteen percent had serum albumin concentrations < 35 g/L (3.5 g/dL). More than one-half of the subjects reported symptoms of oral health problems. The key dependent variables were serum albumin concentration and BMI. In univariate analyses, a lower BMI correlated with oral symptoms, male sex, increased age, and less education. Lower serum albumin concentrations were associated with advanced age, increased dependence in Activities of Daily Living (ADL), oral symptoms, and presence of a caregiver. A stepwise multiple-regression model for BMI and serum albumin showed that predictors of low BMI were increased age, less education, difficulty in chewing, and absence of dentures. Variables in the model for lower serum albumin concentrations were sex, increased age, increased dependence in ADLs, and wearing of dentures. In a secondary analysis that controlled for age, education level, functional status, and sex, oral symptoms remained associated with lower BMI but not with lower serum albumin concentrations. This study found a high prevalence of undernutrition in urban homebound older adults and suggests that oral health disability may affect nutritional status in this population.