Using verbal fluency to detect very mild dementia of the Alzheimer type

The study sample included 76 healthy older adults and 77 individuals with very mild dementia of the Alzheimer type (DAT). Semantic (animal) and letter (S and P) fluency tasks were used to examine quantitative (word generation) and qualitative (category clustering and switching) aspects of verbal fluency. The goal of the study was to evaluate the utility of fluency tasks in discriminating between healthy aging and very mild DAT. Our results indicated better performance for the healthy group than the DAT group in terms of number of words, number of clusters, number of switches, and size of clusters generated (an exception was clustering on letter S fluency). Clustering and switching variables were significantly correlated with number of words generated and therefore were not included in discriminant analysis. Discriminant analysis revealed that the combination of semantic fluency and narrative recall may be particularly useful in differentiating healthy aging from very mild DAT.

Revisiting inhibitory control across the life span: insights from the ex-Gaussian distribution

Changes in inhibitory control occur across the life span and have been associated with alterations in prefrontal function. In this study, ex-Gaussian analysis was used to reexamine data from an inhibitory control task. Participants (ages 6 to 82 years) composed three groups: children, young adults, and older adults. In fitting the ex-Gaussian distribution to reaction time data, estimates of three parameters were obtained: mu (mu), reflecting average performance; sigma (sigma), reflecting variability in performance; and tau (tau), reflecting extremes in performance. Older adults differed from young adults in terms of mu, sigma, and tau. For children, mu and tau values were comparable to those of young adults; sigma, however, was different. Thus, inhibitory changes in older adults were due to slower, more variable, and more extreme responding. Inhibitory changes in children were due only to more variable responding. These findings suggest that different mechanisms underlie age-related changes in inhibitory control during different epochs of the life span. This study demonstrates that the ex-Gaussian approach provides a finer level of analysis than data analytic approaches typically used in neuropsychological research.

Oral health habits amongst children in the United Kingdom in 2003

BACKGROUND

The 2003 Children's Dental Health Survey is the fourth in a series of decennial national children's dental health surveys.

AIMS

This paper presents data on parental attitudes towards the care of children's teeth and gums, reported oral hygiene behaviours and clinical measures of hygiene and periodontal health in 2003 and highlights trends since previous surveys.

METHOD

A total of 10,381 children were examined in schools by trained and calibrated examiners. Four measures of hygiene and periodontal health were recorded as part of the clinical examination. In addition, 3,342 questionnaires were completed by parents of a sub-sample of these children. The questionnaire enabled information to be collected about reported oral health behaviours and parental attitudes.

RESULTS

About three quarters of children across all age groups are reported to brush their teeth twice daily. A range of oral health products was reported as being used in addition to toothbrushes and toothpaste. There is a trend in parental preferences towards restoration of teeth rather than extractions and towards a better understanding of dental caries prevention. Although overall a higher proportion of children in this survey appeared to have gingival inflammation, plaque and calculus than 10 and 20 years ago, there was no change in the proportion of older children with gingivitis.

CONCLUSIONS

Dental practitioners have a role to play in reinforcing these positive attitudes and encouraging appropriate and effective oral hygiene behaviours in their child patients.

Patterns of care and service use amongst children in the UK 2003

BACKGROUND

The 2003 Children's Dental Health Survey is the fourth of the 10-yearly surveys of children's oral health in the United Kingdom.

AIM

To detail the reported experience of dental services and dental treatment amongst children in the UK.

METHOD

A self-completion questionnaire was distributed to a 50% sub-sample of parents or carers of the children who were clinically examined in the 2003 UK Child Dental Health Survey. This included questions relating to parental and child experience of dental services and dental treatment.

RESULTS

The proportion of UK five-year-olds reported as not having visited the dentist fell from 14% in 1983 to 6% in 2003 and the proportion reported as having visited the dentist before the age of two rose from 7% in 1983 to 31% in 2003. Over 80% of all children were reported to seek regular dental check-ups. Around 10% were reported to have had some difficulty in accessing NHS dental care while 5% of five-year-olds were reported to have experienced a general anaesthetic for dental procedures in 2003. Dental attendance was associated with social class and mothers' reported attendance patterns.

CONCLUSIONS

In line with previously reported trends, the 2003 survey of children in the United Kingdom shows improvements in several areas but some aspects of attendance pattern continue to be associated with social class and mothers' attendance pattern. It is of concern that 10% of five-year-olds reported having experienced extractions and 5% general anaesthesia for dental treatment.

Non-carious tooth conditions in children in the UK, 2003

BACKGROUND

The 2003 Children's Dental Health Survey is the fourth of the 10-yearly surveys of children's oral health.

AIM

To report the prevalence of three non-carious tooth conditions in children in the UK.

METHOD

A representative sample of children five, eight, 12 and 15 years of age were examined by calibrated examiners in schools across the UK. The dental examination included accidental damage to incisors, tooth surface loss (TSL) and enamel opacities (age 12 only). A postal questionnaire sought parental and child views on marks on teeth which could not be removed by brushing.

RESULTS

The proportion of children sustaining accidental damage to permanent incisors decreased to 11% of 12 and 13% of 15-year-olds, but the majority of accidental damage remained untreated. TSL was found on 53% of five-year-olds and on approximately a third of 12 and 15-year-olds. There was a statistically significant change for TSL on permanent teeth at age 15 where 27% upper incisors had TSL palatally in 1993 compared to 33% in 2003. Thirty-four per cent of 12-year-old children had enamel opacities on one or more of their teeth compared with 36% in 1993.

CONCLUSIONS

Tooth surface loss remains a common finding in children in the UK. A large proportion of accidental damage to teeth remains untreated.

Cognitive screening for silent cerebral infarction in children with sickle cell disease

Silent cerebral infarctions have been shown to cause major morbidity in children with sickle cell disease, suggesting that silent infarctions are not as "silent" as once thought. The current definition of silent infarction includes signal changes on magnetic resonance imaging, the absence of overt abnormalities on neurologic examination, and no history of focal neurologic event. Using a decision tree algorithm, we identified a cognitive profile distinguishing children with (n=16) and without (n=49) silent infarctions. The best model combined learning slope from the California Verbal Learning Test-Children's Version and Block Design from the Wechsler Abbreviated Scale of Intelligence. Accuracy was 75%, with 75% sensitivity and 76% specificity. Administration of a brief cognitive battery may be the most feasible approach to screen for silent infarctions in children with sickle cell disease.

The circadian rhythm of angina pectoris

Analysis of diary card data from 33,999 angina attacks recorded in 1,022 patients with chronic stable angina showed a clear circadian pattern to the frequency of angina that resembles patterns previously described for myocardial infarction and sudden cardiac death, with a peak in the morning. The majority of angina attacks were preceded by physical exertion and the circadian pattern was more pronounced for exertional angina than nonexertional angina. In this study, treatment with beta-blockers did not prevent the morning peak of angina attacks.

Histone deacetylases in acute myeloid leukaemia show a distinctive pattern of expression that changes selectively in response to deacetylase inhibitors

Histone deacetylase inhibitors (HDIs) are a new class of drugs with significant antileukemic activity. To explore mechanisms of disease-specific HDI activity in acute myeloid leukaemia (AML), we have characterised expression of all 18 members of the histone deacetylase family in primary AML blasts and in four control cell types, namely CD34+ progenitors from umbilical cord, either quiescent or cycling (post-culture), cycling CD34+ progenitors from GCSF-stimulated adult donors and peripheral blood mononuclear cells. Only SIRT1 was consistently overexpressed (>2 fold) in AML samples compared with all controls, while HDAC6 was overexpressed relative to adult, but not neo-natal cells. HDAC5 and SIRT4 were consistently underexpressed. AML blasts and cell lines, exposed to HDIs in culture, showed both histone hyperacetylation and, unexpectedly, specific hypermethylation of H3 lysine 4. Such treatment also modulated the pattern of HDAC expression, with strong induction of HDAC11 in all myeloid cells tested and with all inhibitors (valproate, butyrate, TSA, SAHA), and lesser, more selective, induction of HDAC9 and SIRT4. The distinct pattern of HDAC expression in AML and its response to HDIs is of relevance to the development of HDI-based therapeutic strategies and may contribute to observed patterns of clinical response and development of drug resistance.

Executive control of learning and memory in children with bilateral spastic cerebral palsy

Executive control of learning and memory was examined in children with bilateral spastic cerebral palsy (SCP). We hypothesized that SCP-related brain damage would disrupt executive but not associative aspects of learning and memory. To test this hypothesis, the California Verbal Learning Test-Children's Version was administered to 16 children with bilateral SCP and 19 control children ranging from 6 to 18 years of age. Controlling for general verbal ability, the groups did not differ in initial learning and retention of information over time, suggesting that associative learning and memory processes subserved by medial temporal brain regions were relatively intact in children with SCP. In contrast, impairments in learning over repeated trials, strategic processing, and inhibition in the SCP group pointed to disruptions in prefrontally-mediated executive aspects of learning and memory. The inhibitory deficit was more pronounced in younger children with SCP, suggesting a developmental delay in this ability.

Architectural mutation and leaf form, for the palmate series

Palmate leaf form occurs in both the ferns and angiosperms. The palmate leaf form, and its variants, is present in distantly separated clades within both ferns and angiosperms. There tend not to be intermediate forms which link these palmate leaves to other leaf forms within the taxonomic groups in question. The recurrence of homoplasious leaf forms in separate taxonomic groups could be a consequence of the algorithmic like mode of leaf growth. Leaves develop through the reiteration of modular units. It is probable that the homoplasious leaf forms in different taxa are derived independently through re-combinations of the parameters in the basic leaf form development algorithm.

Evaluation by dental students of a communication skills course using professional role-players in a UK school of dentistry

This paper reports student (n = 180) feedback on the role-play teaching methodology used in behavioural sciences teaching at The School of Dentistry in Birmingham (UK). The feedback received on this well-established (since 1995) educational programme was collected via questionnaire (100% response rate), requiring Likert scale and free text responses. Generally students reported that they had enjoyed and valued the session. Over two-thirds (69.7%) of students rated the role-players as 'very real' and over three-quarters (78.9%) rated their feedback as 'very fair'. The data collected from this study will inform future curriculum development. Student feedback was very positive and demonstrated that the cohort (86% of all students studying in years 1, 2 and 3) found the use of professional role-players involved in behavioural sciences teaching to be both acceptable and valuable.

Retrograde amnesia in dementia: comparison of HIV-associated dementia, Alzheimer's disease, and Huntington's disease

Remote memory was assessed in persons with HIV-associated dementia (HIV-D), probable Alzheimer's disease (AD), and Huntington's disease (HD) and in healthy controls. The clinical groups were similar in overall dementia severity. Each clinical group exhibited impairments on remote memory tests relative to controls; however, temporally graded memory loss with selective preservation of older information was observed in the AD group but not the HD or HIV-D group. Analysis of cued retrieval indicated a preferential cuing benefit for the HIV-D and HD groups relative to the AD group. The similar pattern of remote memory performance demonstrated by the HIV-D and HD groups is a novel finding and suggests a subcortically mediated retrograde amnesia in HIV-D. The temporally graded pattern and the abnormal cued retrieval performance in the AD group are consistent with a consolidation deficit associated with extrahippocampal (cortical) and hippocampal damage.

An algal removal using a combination of flocculation and flotation processes

The paper describes certain facets of the removal of the algae (Scenedesmus quadricauda) from water, using a froth flotation separation method, in conjunction with two types of surfactants, (cetyltrimethylammonium bromide) CTAB and (sodium dodecylsulfate) SDS. A 90% algal removal efficiency was achieved when 100 mg l(-1) of CTAB was used whereas for the SDS solutions, the same concentration gave, by comparison, a very poor algal removal efficiency. An addition of 1 mg l(-1) of a commercial cationic polyelectrolyte, which was the optimal concentration as was evident from the zeta potential and the particle size distribution measurements, prior to the SDS addition resulted in a formation of algal flocs and consequently a substantial improvement in the extent of the algal removal. A 50 mg l(-1) solution of SDS was found to be the optimal concentration to completely remove these algal flocs from water. The amount of water removed along with the algal flocs, produced using 1 mg l(-1) of the commercial polyelectrolyte and subsequently removed using SDS, was comparatively lower than that removed with the algal cells when CTAB was used as the 'collector'. It was generally found, in this study, that an addition of the polyelectrolyte improved the removal efficiencies and the rate of separation and also decreased the amount of the associated water removed along with the algal sludge.

Facilitators and barriers to improving the quality of referrals for potential oral cancer

The quality and content of referral letters are important for prioritisation of patients who may have oral cancer. Referrals letters to the Oral Medicine Clinic at Birmingham Dental Hospital were analysed and practitioners interviewed. Whilst acceptable for general purposes, most letters did not contain sufficient information to allow effective prioritisation. Interviews disclosed a misunderstanding amongst practitioners about the way in which referrals were handled. A number of barriers to increasing the information included in letters were identified. Referral guidelines and a standardised proforma might help improve the ability of the service to operate a fast-track system.

Diagnosis and management of drug-associated interstitial lung disease

Symptoms of drug-associated interstitial lung disease (ILD) are nonspecific and can be difficult to distinguish from a number of illnesses that commonly occur in patients with non-small-cell lung cancer (NSCLC) on therapy. Identification of drug involvement and differentiation from other illnesses is problematic, although radiological manifestations and clinical tests enable many of the alternative causes of symptoms in advanced NSCLC to be excluded. In lung cancer patients, high-resolution computed tomography (HRCT) is more sensitive than a chest radiograph in evaluating the severity and progression of parenchymal lung disease. Indeed, the use of HRCT imaging has led to the recognition of many distinct patterns of lung involvement and, along with clinical signs and symptoms, helps to predict both outcome and response to treatment. This manuscript outlines the radiology of drug-associated ILD and its differential diagnosis in NSCLC. An algorithm that uses clinical tests to exclude alternative diagnoses is also described.

The diagnostic accuracy and reproducibility of school dental screening using an index of treatment need

OBJECTIVE

To test the use of an index in school screening programmes by assessing its accuracy in determining treatment need, and its reproducibility.

BASIC RESEARCH DESIGN

Diagnostic accuracy was measured against a gold standard, inter-examiner and intra-examiner variation was measured by comparing the results of two examiners for the same subjects. Setting A large inner city primary school in Birmingham.

PARTICIPANTS

570 primary school children.

OUTCOME MEASURES

Diagnostic accuracy was measured by sensitivity and specificity values. Reproducibility was measured by using kappa scores.

RESULTS

The mean sensitivity for positive screening result was 81% and mean specificity for negative screening result was 97%. The kappa score for inter-examiner variation was 0.7 with agreement on decision to refer in 91% of cases. Intra-examiner variation was 11% for both examiners.

CONCLUSION

The use of the index was shown to be both accurate and reproducible and is advocated for use in school dental screening programmes.

The attitudes of undergraduate students and staff to the use of electronic learning

BACKGROUND

Computer-aided learning (CAL) offers advantages over traditional methods of learning as it allows students to work in their own time and pace. The School of Dentistry at the University of Birmingham has created an electronic learning website, named the Ecourse. This is designed to be a web-based supplement to the dental undergraduate curriculum.

AIM

The aim of this study was to determine the attitudes of third year dental students and members of staff about the Ecourse website.

METHOD

A questionnaire was produced and piloted before being distributed to all 65 third year dental students to obtain their opinions about the Ecourse website. The views of Ecourse were sought from four members of staff by performing qualitative, semi-structured interviews.

RESULTS

Lecture handouts and textbooks were reported as the sources used most often, by 96% of students. Eighty-six per cent of students are accessing the Ecourse mainly at the School of Dentistry, but 53% are also accessing it at home. Students liked the multiple-choice questions, downloading extra notes and looking at pictures and animation to explain clinical procedures. The majority of the students (79%) want the Ecourse to be used as a supplement to the undergraduate programme and 7% wanted it to replace formal lectures. Staff recognised the benefits of the Ecourse but were concerned about plagiarism, the effect on lecture attendance and the lack of feedback from students on existing CAL material.

CONCLUSION

Students consider the Ecourse as a positive method of supplementing traditional methods of learning in the dental undergraduate programme. However in contrast teaching staff expressed negative views on the use of e-learning.

Determination of carotenoid and vitamin A concentrations in everted salmonid intestine following exposure to solutions of carotenoid in vitro

Carotenoid (astaxanthin and canthaxanthin) concentrations in everted intestine from rainbow trout (Oncorhynchus mykiss, Walbaum) and Atlantic salmon (Salmo salar, L.) exposed to micelle solubilised carotenoid, have been determined. Following exposure (1 h) to astaxanthin solution (5 mg l(-1)), trout pyloric caeca and mid intestine had higher (P<0.05) mean tissue astaxanthin concentrations (0.50+/-0.08 microg g(-1) and 0.54+/-0.09 microg g(-1), respectively) compared to hind intestine (0.04+/-0.01 microg g(-1); n=11+/-S.E.). Furthermore, the astaxanthin concentration in pyloric caeca (0.50+/-0.08 microg g(-1)) was greater (P<0.05) than that of canthaxanthin (0.11+/-0.01 microg g(-1); n=11, +/-S.E.) when exposed to solutions of similar carotenoid concentration (5.11+/-0.16 mg l(-1) and 5.35+/-0.16 mg l(-1), respectively; n=3+/-S.E.). However, no differences (P>0.05) were recorded between trout and salmon intestinal tissue in terms of astaxanthin concentration following exposure. Trout caeca exposed to astaxanthin solution had significantly (P<0.05) more vitamin A (514.1+/-36.4 microg g(-1)) compared to control tissues (316.5+/-61.7 microg g(-1); n=8+/-S.E.). Vitamin A(1) concentrations in caeca (287.7+/-11.0 microg g(-1)) exposed to astaxanthin solution were significantly higher (P<0.05) compared to controls (174.9+/-26.9 microg g(-1)). However, vitamin A(2) concentrations were not significantly (P>0.05) different (226.3+/-28.2 microg g(-1) and 141.6+/-35.2 microg g(-1), respectively).

Memory strategy training in children with cerebral infarcts related to sickle cell disease

Cerebral infarcts occur in approximately 30% of children with sickle cell disease (SCD), but little information exists regarding remediation of associated cognitive deficits. The authors examined the benefits of training children with infarcts to use memory strategies. Six children with SCD-related infarcts received academic tutoring; three of these children received additional training in memory strategies (silent rehearsal to facilitate short-term memory and semantic organization to facilitate long-term memory). The performance of children receiving strategy training appeared to improve more than that of children receiving only tutoring. Memory in children with SCD-related infarcts may be enhanced through strategy training.

The use of the Internet within a dental school

The Internet is an increasingly popular medium for delivering educational material. The aim of this study was to determine the attitudes of students and their clinical teachers to the use of the Internet within a dental school in the UK. Questionnaires were distributed to undergraduate dental students in the three clinical years and to all their clinical academic teachers. All students and staff have access to computers and Internet at the university. The majority (72%) of students have access to a computer and 53% also have access to the Internet at home. Of the academic staff, 91% have a computer and 68% have access to the Internet at home. The reasons for use of the Internet differed between staff and students. Whilst equal proportions of students used the Internet for dentistry (38%) and for pleasure (35%), a higher proportion of staff used the Internet more for dentistry (36%) than for pleasure (14%). Students highlighted cost and time as barriers to Internet use, whereas staff lacked confidence in their ability to use the Internet. Less than half (44%) of the students are confident in the accuracy of information from the Internet compared to almost two-thirds (64%) of staff. This study revealed differences in the attitudes of staff and students to the use of Internet as a resource for dentistry. Students are positive to the suggestion that lectures should be presented on the web. Most students (74%) did not see that this would influence attendance at lectures whilst 91% of staff stated that it would decrease lecture attendance. In conclusion, this study revealed differences in the attitudes of staff and students to the use of Internet as a resource for dentistry.

Removal of algae using froth flotation

This paper describes the removal of algae and attached water using a froth flotation method as a function of the collector type, aeration rates, the pH of the algal suspension and temperature of operation. Dispersed air flotation was used in this study to remove Scenedesmus quadricaudo. The addition of surfactants such as cetyltrimethylammonium bromide and sodium dodecylsulfate increased the aeration rates and reduced the size of air bubbles. Only cetyltrimethylammonium bromide gave high algal removal (90%) whereas sodium dodecylsulfate gave poor algal removal (16%). However, by decreasing the pH values of the algal suspension, it was possible to increase the algal removal efficiency up to 80%. Low temperature operation had an important effect on reducing the rate of algal removal but when the temperature was 20 degrees C or higher there was little change with further temperature rises. The amount of water removed with the algal phase was reduced by using a two-stage flotation process.

Inhibitory control following perinatal brain injury

Evidence from developmental, lesion, and neuroimaging studies indicates that the prefrontal cortex plays a major role in executive abilities, including inhibitory control. Proficient executive performance, however, relies not only on the integrity of the prefrontal cortex but also on its interactions with other brain regions. In the current study, the authors focused on the effect that early damage to the white matter tracts interconnecting prefrontal and other brain regions has on inhibitory control. Data were collected from 13 children with bilateral spastic cerebral palsy and from a control group of 20 children with no history of neurologic compromise. Converging evidence from 3 separate paradigms is presented that strongly suggests these children experience impairments in inhibitory control. Findings are discussed within the context of current cognitive and neuroanatomical models of inhibition.

Inhibitory control across the life span

Findings from previous research suggest that inhibitory control improves during early childhood and declines during late adulthood. Very few researchers, however, have examined life-span changes in this ability in single studies. Within this life-span context, we investigated 1 type of inhibitory control--the ability to inhibit aprepotent response and generate an incompatible response--in individuals ranging from 6 to 82 years of age. Examination of raw reaction time data revealed a significantly larger inhibitory control effect for children and older adults than for young adults. Using proportional and z score transformations, we demonstrated that a processing speed explanation is sufficient to account for the differences in performance between children and young adults; this explanation, however, did not adequately explain the discrepancy between young and older adults. Taken together, these findings suggest that, above and beyond differences in processing speed, inhibitory control was less efficient in older adults. Our findings are consistent with the assertion that inhibitory control develops quite early and declines at the later end of the developmental spectrum.

Granulomatous Pneumocystis carinii pneumonia in patients with malignancy

BACKGROUND

A review was undertaken of the clinical features and results of diagnostic tests in non-HIV infected patients who developed granulomatous Pneumocystis carinii pneumonia (PCP).

METHODS

A retrospective review was performed of the charts and radiographs of patients with a granulomatous reaction to P carinii identified from computerised pathology records at Memorial Sloan Kettering Cancer Center, a university affiliated tertiary care hospital.

RESULTS

Three cases were identified; the incidence of granulomatous PCP was 3%. All patients had risk factors for PCP and had received high dose corticosteroids which had been stopped. Two patients had received chemotherapy. Presentation was insidious with only mild symptoms; only one patient had fever. Chest radiographs showed a reticulonodular pattern. Bronchoscopy was negative for PCP in all cases and open lung biopsy was necessary.

CONCLUSION

A granulomatous pathological reaction to PCP occurs rarely in patients with malignancy. In these cases the clinical presentation may be atypical and bronchoscopy can be non-diagnostic.