Ice-Cream Substitute for Patients With Kidney Failure.

OBJECTIVE: Quality of life for patients with kidney failure is less than similar-aged, general population counterparts. A large part of the decrease in quality of life is from the change of diet and nutritional restrictions. One way to combat this decrease in quality of life is through oral nutrition supplements. METHODS: An ice-cream substitute product was developed for patients with kidney failure on peritoneal dialysis. The product consisted of an ice-cream-like base of rice milk, egg whites, evaporated coconut milk, sugar, and vanilla bean paste. Two flavors were then created: cinnamon and lemon. Both flavors were tested subjectively and objectively. Sensory taste testing was with peritoneal dialysis patients using a Likert scale ballot with a comment section. Texture analysis was completed using a CT3 Brookfield texture analyzer. The results from the sensory testing (taste, texture, overall acceptability) and the texture analysis were analyzed using paired-samples t-tests. Nutritional analysis for the product was calculated. RESULTS: The sensory test of taste, texture, and overall acceptability between the two flavors was not found to be statistically different between the cinnamon and lemon. Similarly, the objective results were also not statistically significant between the two flavors. CONCLUSION: Based on the nutritional analysis, both the lemon and the cinnamon flavors were found to be "good" sources of protein when compared with the Food and Drug Administration's definition of a "good" source of protein. In addition, patients found the sensory aspects of both flavors to be slightly to moderately likable.

Vitamin D status is associated with muscular strength in a nationally representative sample of US youth.

AIM: To evaluate the association between serum 25-hydroxyvitamin D (25OHD) and muscular strength in a nationally representative sample of US youth. METHODS: Participants (n = 3350) were 6- to 18-y-olds from 2011 to 2014 National Health and Nutrition Examination Survey. Relative handgrip strength was quantified using age- and sex-specific z-scores. Poor strength was defined as those <25th percentile. Multivariate general linear and logistic models were used to compare strength and poor strength status by clinically relevant groupings of 25OHD. RESULTS: Approximately 20.2% of youth had 25OHD <50 nmol/L. Mean relative strength was highest for those at ≥75 nmol/L of 25OHD. The percentage of boys/girls with poor strength in the <50 nmol/L, 50-74.9 nmol/L and ≥75 nmol/L groups was 34.9%/32.3%, 25.8%/28.2% and 14.0%/15.8%, respectively. The odds of boys and girls with <50 nmol/L 25OHD having poor strength were 2.8 (95% CI: 1.4, 5.5) and 3.4 (1.7, 6.8) times higher compared to those with ≥75 nmol/L, respectively. CONCLUSION: Higher levels of circulating vitamin D were associated with higher relative strength, and poor strength was more prevalent when 25OHD was <75 nmol/L. These findings highlight the value of vitamin D for the muscle-bone unit and potential extraskeletal ramifications.

A Qualitative Exploration of Weight Bias and Quality of Health Care Among Health Care Professionals Using Hypothetical Patient Scenarios.

The purpose of this study was to determine whether weight bias exhibited by health care professionals (HCPs) impacts quality of health care provided to individuals with obesity. HCPs (n = 220; 88% female, 87% nurses) in the Midwest region of the United States were recruited to complete an online survey. In this within-subjects study design, participants completed the Attitudes Towards Obese Persons (ATOP) scale to assess weight bias and responded to 2 (1 person with obesity and 1 person without obesity) hypothetical patient scenarios to evaluate quality of care. A median split was calculated for ATOP scores to divide participants into high or low weight bias groups. Within these groups, thematic analysis was used to uncover themes in quality of care based on participants' responses to each scenario. The analysis revealed that HCPs in the high weight bias group gave specific diet and exercise recommendations, offered health advice regarding weight loss, and used less teaching discourse when responding to the patient with obesity. In addition, in both weight bias groups, patients with obesity were started on pharmaceutical therapies sooner. The findings of this study suggest a need to educate HCPs on the importance of empathy and compassion when providing treatment to all patients, regardless of weight, to increase quality of care and ultimately improve patient outcomes.

Modified Nutritional Recommendations to Improve Dietary Patterns and Outcomes in Hemodialysis Patients.

The renal diet has traditionally been regarded as one of the most complex medical nutrition therapies to teach, understand, and implement. Specifically, patients are instructed to limit fruits, vegetables, nuts, legumes, dairy, and whole grains because of both phosphorus and potassium concerns. Furthermore, hemodialysis patients are often encouraged to decrease fluid intake to control interdialytic weight gain. These restrictions can result in frustration, lack of autonomy, and the perception that there is nothing left to eat. It is possible that the traditional renal diet may be liberalized, with a focus on whole foods low in sodium and phosphorus additives, to afford patients greater choices and ultimately improved outcomes. Therefore, the objective of this review is to concisely assess the evidence in support of a renal diet focused primarily on reducing the intake of sodium and inorganic phosphorus. Finally, the limited evidence for restrictions on dietary potassium intake is summarized.

The five most significant barriers to healthy eating in collegiate student-athletes.

The objective of the present study was to elucidate what student-athletes believe are the most significant barriers to consuming a healthy diet. 418 student-athletes at an NCAA Division 1 university were invited to complete a survey on their nutritional habits and barriers to healthy eating. The survey was designed utilizing the current literature in student-athletes and young adults and underwent a professional review and pilot study before use in data collection. 169 student-athletes (40%) fully completed the survey. Responses indicate the five most significant barriers are lack of time, easy access to unhealthy foods, cost of healthy foods, lack of knowledge about what foods are healthy, and lack of knowledge and skills to cook healthy foods, respectively. Further, data show significant relationships between several variables and the rate of selection of various barriers. Overall, these findings lay the groundwork for future interventions while also presenting initial, usable information for professionals.

The measurement of college athletes' knowledge and behavior on pre- and post-workout nutrition utilizing a text message intervention.

Objective: The purpose of this study was to measure college student athletes' nutrition knowledge and behavior before and after a text message-based educational intervention. Participants: Athletes (n = 35) participated by completing a pre- and post-intervention survey. Methods: This survey gathered information on ability to identify carbohydrate and protein food sources, pre-and post-workout intake, and behavior. Text messages were sent during the 4-week intervention and included information regarding the importance of carbohydrate consumption before training, and a carbohydrate-protein mixture for recovery. Results: Dependent t-tests revealed a lack of statistically significant increases in total knowledge (p = 0.156) or behavior (p = 0.177), but an increase in the behavior questions regarding efficacy of carbohydrate before training (p = 0.026) and carbohydrate and protein after training (p = 0.016). Conclusion: This suggests the text message educational intervention did influence behavioral outcomes. Future research should focus on the effectiveness, length, and frequency of the text message intervention, and investigate the athletes' willingness to change dietary behaviors.

CSF from Parkinson disease patients differentially affects cultured microglia and astrocytes.

BACKGROUND: Excessive and abnormal accumulation of alpha-synuclein (α-synuclein) is a factor contributing to pathogenic cell death in Parkinson's disease. The purpose of this study, based on earlier observations of Parkinson's disease cerebrospinal fluid (PD-CSF) initiated cell death, was to determine the effects of CSF from PD patients on the functionally different microglia and astrocyte glial cell lines. Microglia cells from human glioblastoma and astrocytes from fetal brain tissue were cultured, grown to confluence, treated with fixed concentrations of PD-CSF, non-PD disease control CSF, or control no-CSF medium, then photographed and fluorescently probed for α-synuclein content by deconvolution fluorescence microscopy. Outcome measures included manually counted cell growth patterns from day 1-8; α-synuclein density and distribution by antibody tagged 3D model stacked deconvoluted fluorescent imaging. RESULTS: After PD-CSF treatment, microglia growth was reduced extensively, and a non-confluent pattern with morphological changes developed, that was not evident in disease control CSF and no-CSF treated cultures. Astrocyte growth rates were similarly reduced by exposure to PD-CSF, but morphological changes were not consistently noted. PD-CSF treated microglia showed a significant increase in α-synuclein content by day 4 compared to other treatments (p ≤ 0.02). In microglia only, α-synuclein aggregated and redistributed to peri-nuclear locations. CONCLUSIONS: Cultured microglia and astrocytes are differentially affected by PD-CSF exposure compared to non-PD-CSF controls. PD-CSF dramatically impacts microglia cell growth, morphology, and α-synuclein deposition compared to astrocytes, supporting the hypothesis of cell specific susceptibility to PD-CSF toxicity.

Pilot feasibility study examining the effects of a comprehensive volume reduction protocol on hydration status and blood pressure in hemodialysis patients.

INTRODUCTION: Chronic volume overload is a persistent problem in hemodialysis (HD) patients. The purpose of this study was to investigate the impacts of comprehensive volume reduction protocol on HD patient's hydration status and blood pressure (BP). METHODS: Twenty-three HD patients (age = 55.7 ± 13.3 years) completed a 6-month comprehensive volume control protocol consisting of: reducing postdialysis weight; reducing BP medication prescriptions; and weekly intradialytic counseling to reduce dietary sodium intake and interdialytic weight gain (IDWG). The primary outcome was volume overload (VO) measured by bioelectrical impedance spectroscopy. Secondary outcomes included: IDWG, postdialysis weight, estimated dry weight (EDW), dietary sodium intake, BP and BP medication prescriptions. FINDINGS: From baseline (0M) to 6 months (6M), significant improvements were noted in: VO (0M 3.9 ± 3.9 L vs. 6M 2.6 ± 3.4 L, P = 0.003), postdialysis weight (0M 89.4 ± 23.1 kg vs. 6M 87.6 ± 22.2 kg; P = 0.012), and EDW (0M 89.0 ± 23.2 vs. 6M 86.7 ± 22.5 kg., P = 0.009). There was also a trend for a reduction in monthly averaged IDWG (P = 0.053), and sodium intake (0M 2.9 ± 1.6 vs. 6M 2.3 ± 1.1 g/d, P = 0.125). Neither systolic BP (0M 162 ± 27 vs. 6M 157 ± 23 mmHg, P = 0.405) nor diastolic BP (0M 82 ± 21 vs. 6M 82 ± 19 mmHg, P = 0.960) changed, though there was a significant reduction in the total number of BP medications prescribed (0M 3.0 ± 1.0 vs. 6M 1.5 ± 1.0 BP meds; P = 0.004). DISCUSSION: Our volume reduction protocol significantly improved HD patient's hydration status. While BP did not change, the reduction in prescribed BP medication number suggests improved BP control. Despite these overall positive findings, the magnitude of change in most variables was modest. Comprehensive changes in HD clinics may be necessary to realize more clinically significant results.

Fluorescence microscopy and 3D image reconstruction of cytokine initiated disruption of the Parkinson disease associated proteins alpha-synuclein, tau and ubiquitin in cultured glial cells.

Human derived glioblastoma cells were cultured and treated with cytokines interleukin-6 (IL6), tumor necrosis factor alpha (TNF) and interferon-gamma (IFN) and imaged by fluorescence deconvolution microscopy to localize alpha-synuclein, tau and ubiquitin. Exposures were for short (2 h) and prolonged times (up to 96 h), with doses at both low (10 ng/ml), and high (100 ng/ml) concentrations. Further experiments used additive doses up to 200 ng/ml (2 x 100 ng), mimicking a super-infection state. Single, low doses of the cytokines initiated changes in levels of intracellular proteins, but these changes, be they increases or decreases, were not sustained, so we added higher doses of cytokine to the culture medium or fresh aliquots of cytokines over time. Finally, we treated cells with high, single doses of cytokine (200 ng/ml), to try to sustain perturbations of the proteins with cytokines. IFN caused a disruption and reduction of peripheral synuclein, TNF treatment resulted in increased levels of ubiquitin and IL6 disrupted and appeared to fragment tau. Of note, each of the proteins was found in a specific locale, tau being perinuclear, ubiquitin residing in the cytoplasm, and alpha-synuclein occupying the tips of cellular processes, exhibiting the characteristics of an adhesion protein/molecule [Word count=198].

Enumeration of objects and substances in non-human primates: experiments with brown lemurs (Eulemur fulvus).

Both human infants and adult non-human primates share the capacity to track small numbers of objects across time and occlusion. The question now facing developmental and comparative psychologists is whether similar mechanisms give rise to this capacity across the two populations. Here, we explore whether non-human primates' object tracking abilities are subject to the same constraints as those of human infants. In particular, we examine whether one primate species, the brown lemur (Eulemur fulvus), also fails to represent and enumerate objects when they behave non-rigidly or non-cohesively. We presented lemurs with a series of expectancy violation studies involving simple 1 + 1 addition events in which we varied the entities to be enumerated. Like infants, lemurs successfully enumerated the two objects when those objects were rigid, cohesive individuals, but failed to enumerate similar-looking non-rigid piles of sand. In contrast to human infants, however, lemurs successfully enumerated non-cohesive objects that broke into multiple pieces. These results are discussed in light of recent theories about object processing in human infants and adults.

'Unwilling' versus 'unable': capuchin monkeys' (Cebus apella) understanding of human intentional action.

A sensitivity to the intentions behind human action is a crucial developmental achievement in infants. Is this intention reading ability a unique and relatively recent product of human evolution and culture, or does this capacity instead have roots in our non-human primate ancestors? Recent work by Call and colleagues (2004) lends credence to the latter hypothesis, providing evidence that chimpanzees are also sensitive to human intentions. Specifically, chimpanzees remained in a testing area longer and exhibited fewer frustration behaviors when an experimenter behaved as if he intended to give food but was unable to do so, than when the experimenter behaved as if he had no intention of giving food. The present research builds on and extends this paradigm, providing some of the first evidence of intention reading in a more distant primate relative, the capuchin monkey (Cebus apella). Like chimpanzees, capuchin monkeys distinguish between different goal-directed acts, vacating an enclosure sooner when an experimenter acts unwilling to give food than when she acts unable to give food. Additionally, we found that this pattern is specific to animate action, and does not obtain when the same actions are performed by inanimate rods instead of human hands (for a similar logic, see Woodward, 1998). Taken together with the previous evidence, the present research suggests that our own intention reading is not a wholly unique aspect of the human species, but rather is shared broadly across the primate order.

Brief Report: Does Watching The Good Doctor Affect Knowledge of and Attitudes Toward Autism?

Individuals' knowledge and attitudes about autism spectrum disorder (ASD) work together to shape the stigma held about ASD. One way that this information is communicated to the public is through popular media; however, little is known about the effectiveness of fictional depictions of ASD in educating and shaping attitudes about ASD. The purpose of this research was to investigate the impact media has on knowledge about and attitudes towards ASD, compared to that of a college lecture on the subject. Exposure to one episode of a fictional drama depicting ASD, compared to watching a lecture, resulted in more accurate knowledge, more positive characteristics associated with ASD, fewer negative characteristics associated with ASD, and a greater desire to learn more about ASD.

Gastrointestinal Microbiota in Patients with Chronic Kidney Disease: A Systematic Review.

Emerging evidence suggests that gastrointestinal (GI) microbiota dysbiosis is associated with chronic kidney disease (CKD) and metabolite concentrations. The purpose of this systematic review was to evaluate and contextualize the research characterizing GI microbiota in patients with CKD. We searched for full-text, peer-reviewed, English studies in PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Google Scholar using a combination of MeSH terms and keywords. Eleven of the 20 studies examined GI microbiota in patients with CKD, and 9 studies focused on the effect of interventions on GI microbiota or metabolites. Available data characterizing GI microbiota in patients with CKD suggest a decline in saccharolytic bacteria and an increase in fermenters of nitrogen-containing compounds, serving as a source for circulating uremic toxins. However, studies examined limited sets of predetermined microbes, which do not reflect the entire GI microbial community and its influence on host physiology. We recommend further studies examining the entire microbial community and the potential role in regulating host physiology in CKD.

Registered dietitian nutritionists and perceptions of liberalizing the hemodialysis diet.

BACKGROUND/OBJECTIVES: The objective of this study was to assess the level of awareness, comfort, and likelihood of liberalizing the hemodialysis diet in practicing renal registered dietitian nutritionists (RDN). SUBJECTS/METHODS: An original, cross-sectional survey was sent to the Academy of Nutrition and Dietetics' Renal Practice Group in May 2017, consisting primarily of renal dietitians. RESULTS: A total of 187 renal dietitians responded to the survey designed to assess their current practices regarding the renal diet for hemodialysis patients and how comfortable they would be liberalizing the current restrictions. On average, 16.3% of dietitians are extremely likely to liberalize the restrictions on various food groups including fruits and vegetables, beans and legumes, and whole grains. CONCLUSIONS: RDN feel confident in their ability to interpret and apply evidence-based literature into practice, and they are moderately comfortable liberalizing the renal diet. The participants were generally more comfortable liberalizing the phosphorus restriction than the potassium restriction, and the sodium restriction remains important to control interdialytic weight gain and hypertension. Future research is needed to establish efficacy of a liberalized diet as well as interventions to help RDN feel more comfortable implementing a liberalization of the renal diet.

Enteral Nutrients and Gastrointestinal Physiology.

The gastrointestinal (GI) tract is a highly efficient organ system with specialized structures to facilitate digestion and absorption of nutrients to meet the body's needs. The presence of nutrients in the GI tract supports optimal structure and function, stimulates regulatory hormones, and supports the microbiota, the population of microorganisms residing in the GI tract. A lack of enteral nutrition (EN) results in impaired GI integrity and serious patient complications, making EN a priority. Normal GI physiology is reviewed, and the regulatory impact of luminal nutrients on GI function is discussed.

Co-occurring Risk Factors in Multiple Sclerosis.

OBJECTIVE: We examined individual and co-occurring risk factors as correlates of health outcomes in persons with multiple sclerosis (MS). METHODS: Sixty-nine participants with MS completed measures of nutrition, physical activity levels, comorbidity and neuroperformance. The data were analyzed using t-test analyses in SPSS Statistics 22.0. RESULTS: Total number of comorbidities (z = 2.36, p = .02), cardiovascular disease symptoms (z = 2.63, p = .01), Timed 25-Foot Walk (T25FW) speed (z = 2.53, p = .01), and 6 Minute Walk (6MW) distance (z = 2.61, p = .01) had significant differences in the cluster of co-occurring poor nutrition and insufficient levels of physical activity. There was a significant difference between those reporting two vs. one risk factor for number of comorbidities (z = 2.41, p = .02), cardiovascular disease symptoms (z = 2.40 p = .02), T25FW speed (z = 2.39, p = .02), and 6MW distance (z = 2.68, p = .01). CONCLUSIONS: These results suggest that: (1) the cluster of co-occurring poor diet and insufficient physical activity is associated with comorbidities and neuroperformance markers; and (2) that cluster is further synergistically associated with comorbidities and neuroperformance markers.

No support for the claim that literary fiction uniquely and immediately improves theory of mind: A reply to Kidd and Castano's commentary on Panero et al. (2016).

Kidd and Castano (in press) critique our failure to replicate Kidd and Castano (2013) on 3 grounds: failure to exclude people who did not read the texts, failure of random assignment, and failure to exclude people who did not take the Author Recognition Test (ART). This response addresses each of these critiques. Most importantly, we note that even when Kidd and Castano reanalyzed our data in the way that they argue is most appropriate, they still failed to replicate the pattern of results reported in their original study. We thus reaffirm that our replication of Kidd and Castano (2013) found no evidence that literary fiction uniquely and immediately improves theory of mind. Our objective remains not to prove that reading literary fiction does not benefit social cognition, but to call for in-depth research addressing the difficulties in measuring any potential effect and to note the need to temper claims accordingly. (PsycINFO Database Record

Transcranial magnetic stimulation for treatment-resistant depression: Naturalistic treatment outcomes for younger versus older patients.

BACKGROUND: Repetitive transcranial magnetic stimulation (TMS) has been shown to be safe and effective for treatment-resistant depression (TRD) in the general adult population. Efficacy among older (≥60 years) patients, who have a greater burden of cognitive, physical, and functional impairment compared to their younger counterparts, remains unclear. The current study aimed to characterize antidepressant response to an acute course of TMS therapy among patients aged ≥60 years compared to those <60 years in naturalistic clinical practice settings. METHODS: Data were retrospectively collected and pooled for adults with TRD (N =231; n =75 aged ≥60 years and n = 156 <60 years) who underwent an acute course of outpatient TMS therapy at two outpatient clinics. Self-report depression scales were administered at baseline and end of acute treatment. Change on continuous measures and categorical outcomes were compared across older vs. younger patients. RESULTS: Both age groups showed significant improvements in depression symptoms. Response and remission rates did not differ between groups. Age group was not a significant predictor of change in depression severity, nor of clinical response or remission, in a model controlling for other predictors (all p>.05). LIMITATIONS: Limitations include reliance on self-report clinical measures and variability in comorbidity and concurrent pharmacotherapy due to the naturalistic nature of the study. CONCLUSIONS: Results suggest that effectiveness of TMS for TRD is not differentially modified by age. Based on these naturalistic data, age alone should not be considered a contraindication or poor prognostic indicator of the antidepressant efficacy of TMS.

Individual and Co-occurring SNAP Risk Factors: Smoking, Nutrition, Alcohol Consumption, and Physical Activity in People with Multiple Sclerosis.

Background: Smoking, poor nutrition, excess alcohol consumption, and insufficient physical activity underlie most preventable causes of morbidity in the general population and may be associated with comorbidities and health outcomes in multiple sclerosis (MS). However, the frequency of co-occurrence of these risk factors in people with MS remains unclear. Methods: Sixty-nine individuals with MS completed self-report measures of smoking status, nutrition, alcohol use, physical activity levels, and sociodemographic and clinical characteristics. The data were analyzed using t tests and χ2 analyses. Results: Poor diet was the most common risk factor, with 85.5% of the sample not meeting dietary guidelines. Of participants with two risk factors, 90.3% were not meeting dietary and physical activity guidelines. Seventy-three percent of women were not meeting physical activity guidelines, compared with 38% of men (χ2 = 7.5, P < .01). There were also differential rates by sex of the most commonly co-occurring risk factors: 65% of women reported the co-occurrence of insufficient physical activity and poor diet, compared with 38% of men (χ2 = 4.2, P = .05). Conclusions: These results indicate that 85.5% of the sample was not meeting nutrition guidelines, 90.3% of participants with two risk factors reported the co-occurrence of poor diet and insufficient levels of physical activity, and physical activity levels and the total number of risk factors varied across sex.

Does reading a single passage of literary fiction really improve theory of mind? An attempt at replication.

[Correction Notice: An Erratum for this article was reported in Vol 111(5) of Journal of Personality and Social Psychology (see record 2016-50315-003). In the article, due to an error in stimulus construction, four items (three authors, one foil) were omitted from the ART presented to all participants tested by Research Group 1. These omissions do not undermine the results in the primary analyses, which all included ART and ART Condition (as covariates). Any variation across research groups, including this difference in reading exposure measurement, is accounted for in the multilevel analyses. Therefore, the Table 2 title should appear as Reading the Mind in the Eyes Test (RMET) Scores by Condition and Overall Unadjusted Means for the Current Study and Kidd and Castano (2013), as Well as the Zero-Order Pearson's Correlations Between RMET and ART Scores Overall and by Condition. The ART data columns should be deleted, and the table note should begin as follows: RMET scores were transformed to correct for skew prior to correlational analyses. The section title above the Discussion section should appear as Comparison of Our RMET Scores to Kidd and Castano Data, with the first two sentences appearing as follows: To determine whether the responses in our sample were similar to what Kidd and Castano (2013) found, we compared our mean performance on the RMET to theirs. Our grand mean (26.28) was significantly higher than theirs (25.18), t(1=, 374) = 3.71, p< .001, d = 0.21. All versions of this article have been corrected.] Fiction simulates the social world and invites us into the minds of characters. This has led various researchers to suggest that reading fiction improves our understanding of others' cognitive and emotional states. Kidd and Castano (2013) received a great deal of attention by providing support for this claim. Their article reported that reading segments of literary fiction (but not popular fiction or nonfiction) immediately and significantly improved performance on the Reading the Mind in the Eyes Test (RMET), an advanced theory-of-mind test. Here we report a replication attempt by 3 independent research groups, with 792 participants randomly assigned to 1 of 4 conditions (literary fiction, popular fiction, nonfiction, and no reading). In contrast to Kidd and Castano (2013), we found no significant advantage in RMET scores for literary fiction compared to any of the other conditions. However, as in Kidd and Castano and previous research, the Author Recognition Test, a measure of lifetime exposure to fiction, consistently predicted RMET scores across conditions. We conclude that the most plausible link between reading fiction and theory of mind is either that individuals with strong theory of mind are drawn to fiction and/or that a lifetime of reading gradually strengthens theory of mind, but other variables, such as verbal ability, may also be at play. (PsycINFO Database Record