Effect of different atmospheric and subatmospheric cooking techniques on physical and chemical qualitative properties of pork loin

In this paper, the effects of four cooking procedures were evaluated, two occurring in atmospheric (in ventilated and steam oven) and two in subatmospheric (vacuum and sous vide cooking) conditions on pork Longissimus lumborum. The main objective of the study was to compare and evaluate the physical and chemical characteristics. Samples were cooked in four independent trials namely Oven (O), Steaming (ST), Vacuum Cooking (VC) and Sous Vide (SV). The analyses included temperature, cooking effect, percentage weight loss, texture (cutting and double compression tests), colour (superficially and inside the sample), microstructure (optical microscopy) and fibres shortening analysis. To assess cooking effects on significant nutritional constituents, the fatty acid composition and the content of B vitamins were analysed. Volatile profiles of samples were also compared using solid-phase microextraction. SV cooking resulted in the less favourable meat texture, presenting the highest hardness and chewiness. Moreover, high hardness values measured on SV samples is also related to the high weight loss. The technique of oven cooking (O) demonstrated superior results in terms of mechanical properties, which are closely associated with the cooking values. Specifically, the cook value C0 was significantly higher in the case of oven cooking compared to SV, VC, and ST. Mild temperature conditions and cooking times of the four considered cooking techniques did not induce significant variations in the fatty acid composition and volatile profile. Conversely, SV and VC allowed the highest amount of vitamin B retention in cooked meat. This work suggests that some differences emerged on the effects due to sub-atmospheric and atmospheric cooking compared to traditional ones.

Patient-reported outcomes in melanoma survivors at 1, 3 and 5 years post-diagnosis: a population-based cross-sectional study

PURPOSE

There is a lack of population-based data describing patient reported outcomes (PROs) in melanoma survivors which could guide the development of interventions and resources. This study assessed overall quality of life (QoL), self-reported symptoms and unmet information needs in melanoma survivors 1, 3 or 5 years post-diagnosis.

METHODS

A cross-sectional postal survey was conducted in Victoria, Australia, with eligible melanoma survivors identified from a population-based cancer registry. Patient-reported outcome measures included the EuroQoL 5-Dimension 5-Level (EQ-5D-5L), and self-reported symptoms, difficulties and information needs. Associations between demographic, disease and care-related factors and QoL were also assessed.

RESULTS

A total of 476 melanoma survivors participated in the study (response rate 46.5%). Anxiety and depressive symptoms were more prevalent in survivors compared to the general population (30.7% vs 21.6%; p < 0.01). Fear of cancer recurrence (48.3%) and fear of cancer spreading (37.8%) were the most commonly reported symptom items, and approximately one in five melanoma survivors had unmet information needs related to psychological aspects of living with melanoma. Recurrent melanoma, living in a nursing home, chronic comorbidities, and melanoma diagnosed at > 2 mm thickness were associated with lower QoL.

CONCLUSION

A large proportion of melanoma survivors reported ongoing quality of life deficits, fear of cancer recurrence, as well as unmet information needs up to 5 years after diagnosis. Patients may benefit from tailored informational resources and interventions that address the psychological aspects of living with and beyond melanoma.

The VCCC Research & Education Lead Program: Collective Leadership in Cancer Across Multiple Organisations

Background and context: The Victorian Comprehensive Cancer Centre (VCCC) is Australia´s first formally constituted comprehensive cancer center, based on NCI principles. It is an alliance of 10 organizations: 7 hospitals, 2 medical research institutes and a university, based in Melbourne, Australia. A key goal for the VCCC is to create meaningful collaborations across partner organizations. Aim: The VCCC established the Research & Education Lead (R & E Lead) Program to build leadership capability who can harness the critical mass of talent across the VCCC alliance to work toward optimal integration of cancer research and education into routine patient care. Strategy/Tactics: This VCCC Research & Education Lead Program manifests the foundational principles of the VCCC by systematising and normalizing collaborative activities across the VCCC alliance. The program is a vehicle that allows the VCCC to address its strategic priorities to enable: - better integration of research, education and clinical care - sharing of ideas and knowledge to improve patient outcomes - shared education and training across member organizations Program/Policy process: Clinicians-scientists were appointed to each tumor stream as VCCC R & E Leads (approx. 0.2 EFT). Their role is to build networks of expertise and to drive change that is evidence-based, strategic and agreed across the VCCC alliance, with a focus on the end goal of better outcomes for cancer patients. The program provides the basis for a model of distributed leadership, wherein champions invested in the VCCC concept are embedded in partner organizations. Outcomes: Three R & E Leads were initially appointed as a pilot for 2 years, with a further three leads appointed during this period. Following the pilot, the program has been expanded to encompass 10 tumor streams as well as leads in primary care integration and cancer nursing. Achievements to date have included the development of a Massive Online Open Course in Cancer Survivorship, conduct of numerous symposia and events that upskill the cancer workforce in niche areas identified by the leads as needs, and consensus on the clinical challenges and research priorities to be tackled collectively within each tumor stream. Overarching program benefits included increased engagement and collaboration across partner organizations, more sharing of knowledge, and more participation in collaborative efforts including VCCC strategy development and advocacy. What was learned: A key finding of an interim program evaluation identified that the appointment of clinician-scientists as the leads was an important factor in their ability to cross the boundaries between research and clinical practice and between organizations, and to work closely and cohesively with clinical service leads for the tumor streams.

Presentations to general practice before a cancer diagnosis in Victoria: a cross-sectional survey

OBJECTIVE

To assess variations in the number of general practitioner visits preceding a cancer diagnosis, and in the length of the interval between the patient first suspecting a problem and their seeing a hospital specialist.

DESIGN, SETTING AND PARTICIPANTS

Analysis of data provided to the Cancer Patient Experience Survey (CPES; survey response rate, 37.7%) by 1552 patients with one of 19 cancer types and treated in one of five Victorian Comprehensive Cancer Centre hospitals, 1 October 2012 - 30 April 2013.

MAIN OUTCOME MEASURES

The primary outcome was the proportion of patients who had had three or more GP consultations about cancer-related health problems before being referred to hospital. The secondary outcome was the interval between the patient first suspecting a problem and their seeing a hospital specialist.

RESULTS

34% of the patients included in the final analyses (426 of 1248) had visited a GP at least three times before referral to a hospital doctor. The odds ratios (reference: rectal cancer; adjusted for age, sex, language spoken at home, and socio-economic disadvantage index score) varied according to cancer type, being highest for pancreatic cancer (3.2; 95% CI, 1.02-9.9), thyroid cancer (2.5; 95% CI, 0.9-6.6), vulval cancer (2.5; 95% CI, 0.7-8.7) and multiple myeloma (2.4; 95% CI, 1.1-5.5), and lowest for patients with breast cancer (0.4; 95% CI, 0.2-0.8), cervical cancer (0.5; 95% CI, 0.1-2.1), endometrial cancer (0.5; 95% CI, 0.2-1.4) or melanoma (0.7; 95% CI, 0.3-1.5). Cancer type also affected the duration of the interval from symptom onset to seeing a hospital doctor; it took at least 3 months for more than one-third of patients with prostate or colon cancer to see a hospital doctor.

CONCLUSION

Certain cancer types were more frequently associated with multiple GP visits, suggesting they are more challenging to recognise early. In Victoria, longer intervals from the first symptoms to seeing a hospital doctor for colon or prostate cancer may reflect poorer community symptom awareness, later GP referral, or limited access to gastroenterology and urology services.

Universal truths: Learning from the experience of cancer patients in Australia and England

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Background: Self-reported patient experience data is vital to the design of responsive and relevant health services. Annual Cancer Patient Experience Surveys in England (NHS-CPES) have been used to effectively guide and monitor improvements in patient experience. This study measured baseline cancer patient experience in member hospitals of the Victorian Comprehensive Cancer Centre in Australia, and benchmarked this with cancer patients in England. Methods: The NHS-CPES instrument and methodology was used. A paper-based questionnaire was mailed to 5,722 admitted patients aged >18 years with an eligible ICD-10 code. Australian results were compared to 71,793 patients in England from the 2011/12 NHS-CPES. Results: 37% (2,101) patients responded. Most patients rated their overall care as very good or excellent (91% Australia, 88% England). Having a named nurse specialist was a key predictor of experience. Patients with a specialist nurse were significantly more positive in 50 questions in Australia (77%) and 64 questions in England (98%) compared to patients without one. In both countries, patients with rarer cancers tended to be less positive than those with other cancer types. Australian patients with brain/central nervous system cancers and sarcomas gave the lowest score in 46 questions (71%). Patients with a disability or a long-term condition, and those from minority ethnic groups were also less positive. Relevant patient information was lacking; only 65% of patients in Australia and 77% in England were given understandable written information specific to their care, and a little over half received information about financial entitlements (58% Australia, 52% England). Conclusions: Cancer patient experience using the NHS-CPES has been successfully measured and compared across two different health systems. Findings in Australia are similar to those in England suggesting the same key issues affect all cancer patients. Important areas for quality improvement include the provision of tailored written patient information and the provision of named nurse specialists as part of the model of care. Acknowledgement: The authors thank Quality Health Limited for data analysis and the NHS for permitting use of the NHS-CPES.

Outcomes monitoring of health, behavior, and quality of life after nutrition intervention in adults with type 2 diabetes

OBJECTIVES

To examine changes in health and lifestyle indicators over 6 months in persons with type 2 diabetes mellitus receiving nutrition counseling from a registered dietitian, and to promote dietetics professionals' participation in outcomes monitoring and research.

DESIGN

Prospective, noncontrolled descriptive study.

SUBJECTS

Two hundred forty-four physician-referred adults with type 2 diabetes mellitus from 31 sites who received usual and customary nutrition counseling, and 83 registered dietitians.

MAIN OUTCOME MEASURES

Glycemic control, coronary heart disease risk, self-management behaviors, and quality of life were measured at baseline, 3 months, and 6 months. Dietitians' perceptions of the study were also measured.

STATISTICAL ANALYSIS

Repeated-measures analysis of variance, paired t test, Wilcoxon signed rank test, sign test, Spearman correlation, and chi 2 analysis were conducted.

RESULTS

Weight and glycemic control, coronary heart disease risk, and self-management behaviors improved significantly between baseline and 3 months and baseline and 6 months. Weight, body mass index, and glycosylated hemoglobin value also improved significantly between 3 months and 6 months. Increased time and/or number of sessions with the registered dietitian were associated with weight loss and reduced glycosylated hemoglobin, fasting plasma glucose, total cholesterol, and triglyceride levels. Self-perceived health status and missed workdays were significantly improved at 6 months. Difficulty obtaining current laboratory values, lack of time, and inability to reach subjects for follow-up presented the greatest obstacles for the dietitians.

CONCLUSIONS

Positive outcomes were observed in adults receiving nutrition intervention for type 2 diabetes. Clinical improvements were greatest between baseline and 3 months, with stabilization between 3 months and 6 months, suggesting ongoing intervention is needed to support continued clinical progress. Dietitians found participation in this state affiliate-coordinated research project rewarding.

A problem-based nutrition care model that is diagnostic driven and allows for monitoring and managing outcomes

The provision of quality food and nutrition services is at the core of dietetic practice. It is exciting to have the profession engaged in discussions regarding the development of a standardized care process/model to further enhance the quality of nutrition services. Educators, consultants, and practitioners have already spoken on behalf of such a tool. This article demonstrates how a systematic model, when incorporated into education and practice contributes to improved provision of MNT and adds value to the unique contributions of dietetic professionals. The authors hope that the discussion will continue and that more ideas and suggestions will be forthcoming.

A prospective study of neuroendocrine and immune alterations associated with the stress of an oral academic examination among graduate students

Stressful experiences may influence neuroendocrine, immune and cytokine functioning, as well as physical and psychological well being. The present prospective investigation assessed physiological and behavioral variations in anticipation of a critical oral academic examination among graduate students (i.e. related to a dissertation or comprehensive defense). Relative to matched control subjects, plasma cortisol levels were elevated among graduate students, especially females, 1 h prior to the oral examination, but not 6-8 weeks earlier (at about the time of the submission of the written document). In contrast, mitogen-stimulated (Con-A) lymphocyte proliferation was only reduced 6-8 weeks before the examination. Neither adrenocorticotrophic hormone (ACTH), prolactin, serum interleukin-1beta (IL-1beta) nor mitogen stimulated IL-1beta production was influenced at any time. Although, graduate students did not differ from controls with respect to perceived stress and feelings of mastery, they reported more frequent malaise (e.g. headaches, sore throat, fatigue) than did controls. The present findings suggest that during the course of lengthy anticipatory periods preceding a scheduled stressor, different stress-sensitive, situation-dependent biological processes may be engendered. It is further suggested that cortisol release is most closely aligned with immediate threats, while the immune alterations are sensitive to more distal events, or are subject to adaptation in response to a protracted stressor.

Non-invasive impedance analysis: a new non-invasive test for graft surveillance

Detection of failing grafts with early reoperation is clearly associated with better long-term patency than intervention after graft failure. Duplex ultrasonography is more accurate than ankle:brachial index for graft surveillance, but is expensive, time consuming and technically demanding. Non-invasive estimation of graft impedance is now possible. The present study was undertaken to evaluate the utility of non-invasive impedance in detecting the failing vein graft. Sixty-nine grafts in 51 patients were followed over a period of 12 months (April 1992-March 1993). High risk infrainguinal arterial vein bypass patients were entered into a graft surveillance program. Ankle:brachial index, non-invasive impedance and duplex ultrasonography were performed upon discharge, 1 month after surgery and then at 3-monthly intervals. Non-invasive impedance was measured using a mean Doppler flow signal obtained from both upper and lower ends of the graft paired with the mean pulse volume recording obtained from the distal arterial bed. The mean pulse volume recording and flow signals were digitized by discrete Fourier transform and an impedance index generated. An impedance index > or = 0.5 was considered abnormal. Impedance results were compared with ankle:brachial index, duplex ultrasonography and angiography when appropriate, and detected 28 failing and five failed grafts. Non-invasive impedance achieved a sensitivity of 91% and a specificity of 94%. Similarly, duplex ultrasonography was 91% sensitive and 97% specific, while ankle:brachial index was 58% sensitive and 94% specific. Non-invasive impedance is a simple, inexpensive and effective test which detects the failing graft and is an appropriate first-line alternative to duplex ultrasonography for postoperative graft surveillance.

Repeated ECS differentially affects rat brain 5-HT1A and 5-HT2A receptor expression

We investigated the effect of electroconvulsive shock (ECS), administered five times over 10 days, on 5-HT1A and 5-HT2A receptor mRNA and binding site densities in the rat brain using in situ hybridization histochemistry and quantitative autoradiography. ECS treatment increased 5-HT1A receptor mRNA abundance and binding site densities in the dentate gyrus, but decreased these parameters in the CA3c layer of the hippocampus. No changes in 5-HT1A receptor mRNA and binding sites occurred in other hippocampal subfields, neocortex or raphe nuclei. Repeated ECS was also found to increase 5-HT2A receptor binding site densities in the neocortex and this was accompanied by a non-significant increase in cortical 5-HT2A receptor mRNA abundance. Our study demonstrates that in the rat, repeated ECS produces anatomically and molecularly discrete effects on 5-HT1A and 5-HT2A receptor gene expression. These changes may be relevant to the therapeutic effect of repeated ECS in depression.

The distribution of 5-HT1A and 5-HT2A receptor mRNA in human brain

We have examined the distribution of 5-HT1A and 5-HT2A receptor mRNAs in post-mortem human hippocampus, neocortex, raphe nuclei, cerebellum and basal ganglia using in situ hybridization histochemistry. Receptor transcripts in brains from two males and two females (mean age +/- S.D. = 70 +/- 4 years; post-mortem interval = 29 +/- 6 h) were visualised with 35S-radiolabelled synthetic oligodeoxyribonucleic acid probes. In the hippocampus, 5-HT1A receptor mRNA was present in all fields, especially CA1. In the parahippocampal gyrus and neocortical regions 5-HT1A receptor mRNA was enhanced in superficial and middle laminae. 5-HT1A receptor mRNA was particularly abundant in the raphe and other serotonergic cell groups of the brainstem. The analysis of emulsion dipped sections showed 5-HT1A receptor mRNA to be concentrated in pyramidal neurons, together with the granule cells of the dentate gyrus. In neocortical areas lamina III pyramidal neurons were more heavily labelled than those in lamina V. There was no evidence of glial expression of 5-HT1A receptor mRNA in grey matter or white matter compartments. 5-HT2A receptor mRNA was present in all neocortical areas examined, where it was located in pyramidal neurons, of lamina V more than in those of lamina III, as well as in putative interneurons, especially within lamina IVc of the striate cortex. 5-HT2A receptor mRNA was observed at minimal levels in the hippocampus and not in the raphe. Neither 5-HT1A nor 5-HT2A receptor mRNA were detected in the cerebellum, substantia nigra or striatum. The ability to detect these transcripts at the regional and cellular level will help reveal important details of the 5-HT receptor system in the human brain. This includes the investigation of their putative roles in the normal chemoarchitecture and in pathophysiological brain processes.

Hydroxykynurenine/hydroxyanthranilic acid ratios and febrile convulsions

Hydroxykynurenine/hydroxyanthranilic acid ratios were measured in children with febrile convulsions, afebrile fits, and fever, as well as in healthy controls. Increased ratios were found not only in the children who had fits but also in the children who were febrile and did not have fits. It is suggested that a raised hydroxykynurenine/hydroxyanthranilic acid ratio does not necessarily indicate vitamin B6 deficiency but may represent a nonspecific response of tryptophan metabolism to stress.