Association between oral health status and future dietary intake and diet quality in older men: the PRIME study Objectives: This study investigated whether oral health status, defined as number of natural teeth and subsequent prosthodontic rehabilitation, was associated with future dietary intake and diet quality in older adults in The Prospective Epidemiological Study of Myocardial Infarction (PRIME). Methods: PRIME was originally established to explore cardiovascular risk factors in 50-59 year old men in Northern Ireland (1991-1994). A rescreening phase assessed oral health (2001-2004), while diet was assessed in 2015. Diet quality was characterised by the Dietary Diversity Score and Mediterranean Diet Score. In the current analysis, associations between oral health status, dietary intake and quality were assessed using regression models in 1,096 participants. Results: Amongst study participants, the overall mean number of teeth was 18.5, 51.5% had ≥21 natural teeth and 49.6% wore dentures. Oral health status was categorised into five groups: 21-28 teeth with (n=111) and without (n=453) dentures, 1-20 teeth with (n=354) and without (n=99) dentures and edentate with dentures (n=79). After full adjustment, men with ≥21 teeth and dentures had a higher future intake of fruit, vegetables, and nuts, and diet quality scores, compared to those with <21 teeth with dentures. Edentate men with dentures were less likely to achieve the future fruit dietary recommendation. Conclusions: Having ≥21 natural remaining teeth positively affected the future intake of fruit, vegetables, and nuts, as well as diet quality. Dentures may be beneficial in men with ≥21 natural remaining teeth, as they were associated with an increased future intake of fruit, vegetables, and nuts and better diet quality. Clinical Significance: Oral health status is associated with dietary intake, after an average time period of 13 years, with those with a larger number of natural teeth having a better diet quality. Further research is required to investigate this relationship in larger, diverse populations with more detailed dietary assessment.

The novel Coronavirus-2019 pandemic brings a largely unfamiliar landscape and continual quest for understanding of the spectrum of presentation for this disease. Recent studies have shown endothelial injury as the trigger for the cytokine storm seen in Covid-19 infection. Hypercoagulability and excessive complement activation can lead to a diffuse thrombotic angiopathy and organ dysfunction CASE PRESENTATION: 40 year old Hispanic male with no past medical history presented to the emergency room with weakness, AMS, recurrent hematemesis. Upon arrival, he was immediately intubated for airway protection. On exam pertinent findings included fever of 102 F, response to noxious stimuli only, and scleral icterus. Laboratory data revealed creatinine 8.08 mg/dL, LDH >2500 IU/L, haptoglobin <10 mg/dL, bilirubin 1.2 mg/dL, hemoglobin 6.8 g/dL, platelets 7,000/L with presence of 3+ schistocytes and positive test for COVID-19. PCR was negative for STEC and shigella. Given a PLASMIC score of 7, a presumptive diagnosis of thrombotic thrombocytopenic purpura (TTP) was made and daily plasma exchange (PEX) with dialysis was urgently initiated. A normal ADAMTS13 level led to discontinuation of PEX after 3 sessions; however, after 4 days hemolysis worsened with low C3 complement, therefore PEX was restarted. A complement panel was suggestive of alternative pathway dysregulation. Patient underwent 15 additional sessions of PEX with resolution of hemolysis, improved renal function and mental status.

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STUDIES HAVE SHOWN THAT academic self-concept and academic achievement are closely related and that academic self-concept is multidimensional. Most studies on academic self-concept have been conducted with school age children and little is known about developing academic self-concept in younger children. In this study, we investigated the evolving academic self-concept of a sample of 97 four-year-old children attending four different early childhood settings across Melbourne, Australia, during the year prior to school commencement. Analysis indicated that at this age, academic self-concept remains a global construct rather than distinguishable into literacy and numeracy self-concepts, and has little connection with children's actual performance on a range of assessment measures. In addition, children overestimated their academic self-concept to a lesser degree at the end of the year than at the start of the year. Implications for early childhood education pedagogy are discussed.

AbstractIntroduction:Full nutritional assessments are currently complex and invasive. There is a need for a non-invasive, timely and cost-effective method to assess nutritional status. Evidence indicates the usefulness of saliva in diagnosing oral or systemic disorders. Saliva is suggested to be a reliable and non-invasive matrix in which to measure nutritional biomarkers. The aim of this work was to systematically review the evidence for salivary biomarkers as indicators of nutritional status.Materials and Methods:Studies identifying salivary biomarkers in relation to nutritional status or dietary intake outcomes were included. A search strategy combined terms “saliva” AND “biomarkers” AND “nutrition”. Four databases were searched, MEDLINE, EMBASE, Web of Science and Scopus. All study designs conducted in humans of all ages, from all countries and settings were included. Non-English and animal studies were excluded. Risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool where applicable. (PROSPERO Registration Number:CRD42018107667)Results:6585 papers were identified, 4836 papers remained after removing duplicates, 4715 were irrelevant, 134 full-texts were assessed for eligibility and 64 papers included in the final analysis. A number of potential salivary biomarkers related to nutritional status were identified including: total protein, albumin, prealbumin, transferrin, ferritin and iron. Total protein levels in saliva in malnourished individuals were significantly different to controls in 7/10 studies (70%). In one study conducted in individuals with iron deficiency anaemia (IDA), total protein was significantly different to controls. Albumin levels in malnourished individuals were significantly different to controls in 5/8 studies (62.5%). Prealbumin and transferrin levels in malnourished individuals were significantly different to controls in 3/3 studies (100%). In one study conducted in malnourished individuals, salivary ferritin levels was significantly different to controls. Ferritin levels in individuals with IDA were significantly different to controls in 3/3 studies (100%). Iron levels in individuals with IDA were significantly different in 2/2 studies (100%). However, even within the studies above where significant differences existed, the direction of salivary biomarker differences was sometimes inconsistent. For example, total protein in malnourished individuals was significantly lower than controls in three studies, higher in three studies and one showed mixed findings. In addition, overall the quality of evidence available was very poor.Discussion:Despite conflicting evidence in salivary nutritional biomarkers in individuals with malnutrition or IDA, saliva may be a useful non-invasive matrix to assess nutritional status. Further high quality research exploring the utility of these biomarkers is required.

IntroductionLower tidal volume ventilation, facilitated by veno-venous extracorporeal carbon dioxide removal (vv-ECCO2R), does not improve 90-day mortality in patients with acute hypoxaemic respiratory failure (AHRF). The aim of this analysis was to evaluate the effect of this therapeutic strategy on long-term outcomes.MethodsThis was a prespecified analysis of the REST trial, a UK-wide multicentre randomised clinical trial that compared lower tidal volume ventilation, facilitated by vv-ECCO2R (intervention), with standard care in the treatment of patients with moderate-to-severe AHRF. Mortality to 2 years was assessed, while respiratory function, post-traumatic stress disorder, cognitive function and health-related quality of life were evaluated in survivors at 1 year using standardised questionnaires.ResultsOf 412 patients enrolled into the REST trial, 391 (95%) had 2-year mortality outcome data available. There was no difference in the time to death between intervention and standard care (HR 1.08 (0.81, 1.44); log-rank test p=0.61). 161 patients alive at 1 year provided at least one questionnaire response. There was no difference in respiratory function, post-traumatic stress disorder, cognitive dysfunction or health-related quality of life between patients allocated to intervention or standard care.ConclusionLower-tidal volume ventilation facilitated by vv-ECCO2R does not affect 1-year mortality in patients with moderate-to-severe AHRF. Of the patients who provided questionnaire responses, there was no treatment effect on long-term respiratory function, post-traumatic stress disorder, cognitive dysfunction or health-related quality of life.Trial registration numberClinicalTrials.gov identifier: NCT02654327.

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Many studies of community assembly focus on a single ontogenetic stage (typically adults) when trying to infer assembly processes from patterns of biodiversity. This focus ignores the finding that assembly mechanisms may strongly differ between life‐stages, and the role of ontogenetic dependency: the mechanisms by which one life stage directly affects the composition of another life stage. Within a 4‐ha forest dynamics plot in California USA, we explored how the relative importance of multiple assembly processes shifts across life stages and assessed ontogenetic dependency of seedlings on adults in woody plant communities. To assess variation in assembly processes across life stages, we examined how β‐diversity of adult and seedling communities were each influenced by space and 13 environmental variables (soils, topography) using distance‐based redundancy analysis and variation partitioning. We then assessed the ontogenetic dependency of seedlings on adults by including adult composition as a predictor in the seedling community variation partitioning. We found differences between adult and seedling composition. For the adults, we found 18 species including pines, oaks and manzanitas characteristic of this mid‐elevation forest. For seedlings, we found 11 species, and that oaks made up 75% of all seedlings while only making up 45% of all adults. Adult β‐diversity was primarily explained by space (44.0%) with environment only explaining 18.6% and 37.4% unexplained. In contrast, most of the explained variation in seedling β‐diversity was due to ontogenetic dependency alone (13.6% explained by adult composition) with 1.6% explained by space and the environment jointly, and 62.8% unexplained. Synthesis: Here, we describe a conceptual framework for integrating ontogeny more explicitly into community assembly research and demonstrate how different assembly processes structured adult and seedling β‐diversity in a temperate dry forest. While adult β‐diversity was largely driven by spatial processes, seedling β‐diversity was largely unexplained, with ontogenetic dependency comprising most of the explained variation. These patterns suggest that future assembly research should consider how assembly processes and their underlying mechanisms may shift with ontogeny, and that interactions between ontogenetic stages (ontogenetic dependency) are critical to consider when assessing variation in assembly processes.