•In this study, dietary fiber intake was positively associated with mental health quality of life scores later in life.•This association suggests a role for dietary fiber in mental health, as quality ...of life score can reflect depression risk.•The fiber intake - mental health quality of life score association differs across fiber source (whole grain vs. refined).
Recent studies have reported associations between dietary intake and mental health. Dietary fiber is one nutrient that may modulate mental health, specifically depression risk, through the gut microbiome. We prospectively examined the association between dietary fiber intake and mental health-related quality of life (QOL) scores, a proxy for depressive symptoms, in a cohort of 14,129 post-menopausal women in the Iowa Women’s Health Study.
Dietary intake was assessed at baseline 1986 using a 127-item food frequency questionnaire. Mental health-related QOL scores were assessed at the follow-up questionnaire 2004 using the Mental Health (MH) component and Mental Health Composite (MCS) scales derived from the SF-36 Health Survey. The association between dietary fiber intake and mean QOL scores was examined using linear regression, with adjustment for age, alcohol intake, energy intake, waist-to-hip ratio, physical activity, smoking status, and education.
The median dietary fiber intake was 19.0 g/day, ranging from 1.1 to 89.4 g/day. Multivariable-adjusted mean MH scores were higher among those with higher fiber intake (P for trend = 0.02). For MCS score, the association with fiber intake observed in a model adjusted for age and energy intake became insignificant after multivariable adjustment.
Our study is one of the first prospective analyses of the association between higher dietary fiber intake and increased MH QOL scores later in life. Given a plausible biological mechanism underlying the association between fiber intake and mental health, additional studies are warranted.
Background
Centralization of rectal cancer surgery has been associated with high-quality oncologic care. However, several patient, disease and system-related factors can impact where patients receive ...care. We hypothesized that patients with low rectal tumors would undergo treatment at high-volume centers and would be more likely to receive guideline-based multidisciplinary treatment.
Methods
Adults who underwent proctectomy for stage II/III rectal cancer were included from the Iowa Cancer Registry and supplemented with tumor location data. Multinomial logistic regression was employed to analyze factors associated with receiving care in high-volume hospital, while logistic regression for those associated with ≥ 12 lymph node yield, pre-operative chemoradiation and sphincter-preserving surgery.
Results
Of 414 patients, 38%, 39%, and 22% had low, mid, and high rectal cancers, respectively. Thirty-two percent were > 65 years, 38% female, and 68% had stage III tumors. Older age and rural residence, but not tumor location, were associated with surgical treatment in low-volume hospitals. Higher tumor location, high-volume, and NCI-designated hospitals had higher nodal yield (≥ 12). Hospital-volume was not associated with neoadjuvant chemoradiation rates or circumferential resection margin status. Sphincter-sparing surgery was independently associated with high tumor location, female sex, and stage III cancer, but not hospital volume.
Conclusions
Low tumor location was not associated with care in high-volume hospitals. High-volume and NCI-designated hospitals had higher nodal yields, but not significantly higher neoadjuvant chemoradiation, negative circumferential margin, or sphincter preservation rates. Therefore, providing educational/quality improvement support in lower volume centers may be more pragmatic than attempting to centralize rectal cancer care among high-volume centers.
Objectives
Interhospital transfer is a common strategy to provide high‐quality regionalized care in rural emergency departments (EDs), but several reports have highlighted problems with selection of ...children for transfer. The purpose of this study is to characterize the burden of potentially avoidable transfer (PAT) and to estimate the medical and family‐oriented costs associated with PAT.
Methods
This study was a cohort study of all children treated in Iowa EDs between 2004 and 2013. PAT was defined as a child who was transferred and then either discharged from the receiving ED or admitted for ≤ 1 day, without having any separately billed procedures performed. Costs of care were estimated from 1) medical costs, 2) ambulance transfer, and 3) family costs (travel and lodging).
Results
Over 10 years, 2,117,317 children were included (1% transferred to another hospital). Only 63% were transferred to a designated children's hospital, and PATs were identified in 39% of all transfers. PAT was associated with $909 in additional cost. The conditions most strongly associated with PAT were seizure (additional cost $1,138), fracture ($814), isolated traumatic brain injury without extra‐axial bleeding ($1,455), respiratory infection ($556), and wheezing ($804). Few of these charges are attributable to nonmedical family costs ($21).
Conclusions
Potentially avoidable pediatric interhospital transfer is common and is responsible for significant healthcare‐related costs. Future work should focus on improving selection of children who benefit from interhospital transfer for high‐yield conditions, to reduce the costly and distressing burden that PAT places on rural patients and their families.
To use medical claims data to determine patterns of healthcare utilization in children with intellectual and developmental disabilities, including frequency of service utilization, conditions that ...require hospital care, and costs.
Medicaid administrative claims from 4 states (Iowa, Massachusetts, New York, and South Carolina) from years 2008-2013 were analyzed, including 108 789 children (75 417 male; 33 372 female) under age 18 years with intellectual and developmental disabilities. Diagnoses included cerebral palsy, autism, fetal alcohol syndrome, Down syndrome/trisomy/autosomal deletions, other genetic conditions, and intellectual disability. Utilization of emergency department (ED) and inpatient hospital services were analyzed for 2012.
Children with intellectual and developmental disabilities used both inpatient and ED care at 1.8 times that of the general population. Epilepsy/convulsions was the most frequent reason for hospitalization at 20 times the relative risk of the general population. Other frequent diagnoses requiring hospitalization were mood disorders, pneumonia, paralysis, and asthma. Annual per capita expenses for hospitalization and ED care were 100% higher for children with intellectual and developmental disabilities, compared with the general population ($153 348 562 and $76 654 361, respectively).
Children with intellectual and developmental disabilities utilize significantly more ED and inpatient care than other children, which results in higher annual costs. Recognizing chronic conditions that increase risk for hospital care can provide guidance for developing outpatient care strategies that anticipate common clinical problems in intellectual and developmental disabilities and ensure responsive management before hospital care is needed.
Personality changes in older adults with brain disease may be confounded by effects of normal aging. In this cross-sectional study, ratings with the Iowa Scales of Personality Change for 62 healthy ...older adults (OA-H, aged 60+) were compared to matched older adults with brain diseases (OA-BD). OA-H did not show any significant personality changes from middle age to older adulthood. However, between 10% and 20% of OA-H developed a disturbance in Lack of Stamina, Inflexibility, Lability, and Lack of Insight. Otherwise, the pattern of findings suggesting normal aging effects on personality disturbances in clinical groups are generally minimal.
Dolomite cement is a significant and widespread component of Phanerozoic sucrosic dolomites. Cements in dolomites that were never deeply buried are limpid, have planar faces (non-saddle forms), often ...distinct zonation in cathodoluminescence and form syntaxial overgrowths on crystals facing pores. Five samples of sucrosic dolomites, interpreted as having had mostly lime-mudstone or wackestone precursors in four carbonate aquifers, provide insights into the abundance of planar cements in sucrosic dolomites. Such cement comprises 11% to 45% (32% mean) of peritidal to sub-tidal dolomites on an outcrop in the Edwards aquifer (Early Cretaceous) of central Texas; 19% to 33% (25% mean) of ramp dolomites in the Hawthorn Group (Oligo-Miocene) and 50% to 70% in shelf dolomites of the Avon Park Formation (Eocene) in the Upper Floridan aquifer of sub-surface peninsular Florida; 18% to 45% (32+% mean) of sub-tidal shelf dolomites in quarry sections of the Burlington-Keokuk Formation (Early Mississippian) in south-eastern Iowa; and 18% to 76% (50% mean) in shallow cores and outcrops of outer-shelf dolomites from the Gambier Limestone (Oligo-Miocene) of South Australia. Backstripping the cement phases revealed by cathodoluminescence colour photomicrographs documents the effects of cements on textural coarsening, pore-space reduction, induration and general 'maturation' of these dolomites. Most pre-Holocene dolomites are multiphase crystalline rocks composed of: (i) seed crystals or 'cores'; (ii) crystal cortices that concentrically enlarged the cores; and (iii) free-space, syntaxial precipitates of limpid cement around the crystals. Remaining CaCO₃ grains and micrite can be replaced by dolomite, but typically they are dissolved between stages (ii) and (iii), creating systems of intercrystal and mouldic pores typical of sucrosic dolomites. Networks of cement overgrowths, aided by water-filled pore systems under hydrostatic to lithostatic pressure, are judged to slow or prevent compaction in sucrosic dolomites. It can be argued that cortex growth involves both replacement of CaCO₃ particles and microcementation of their interparticle pores. This interpretation, and the abundance of cements in so many dolomites, would obviate the controversy over the volumetrics of 'replacement dolomitization'. Limpid, planar and syntaxial dolomite cements of early diagenetic origin are interpreted to have precipitated from clear pore waters, at low temperatures (<30 to 35 °C) and shallow burial depths (<100 m), in water-saturated networks of dolomite 'silt' and 'sand'. Cements in many dolomites in island and continental-aquifer systems appear to result from event-driven processes related to sea-level highstands. Cementation events can follow 'replacement dolomitization' events by time intervals ranging from geologically 'instantaneous' to tens of million years.
The Surface Water and Ocean Topography (SWOT) mission will measure water surface elevations and inundation extents of rivers of the world but with limited temporal sampling. By comparing flood ...location and duration of 4,664 past flood events recorded by the Dartmouth Flood Observatory to SWOT's orbit ephemeris, we estimate that SWOT would have seen 55% of these, with higher probabilities associated with more extreme events and with those that displaced more than 10,000 people. However, SWOT measurements will exhibit uneven temporal sampling and may require a combination of data obtained at different times to accurately characterize large events. This is illustrated using recent flooding in the United States, in eastern Iowa and in Houston and surrounding areas from Hurricane Harvey. SWOT data have significant potential to improve flood forecasting models by offering data needed to enhance flow routing modeling, provided that users can overcome the potential hurdles associated with its temporal and spatial sampling characteristics.
Plain Language Summary
The Surface Water and Ocean Topography (SWOT) satellite mission will simultaneously measure water surface elevations and inundated areas for the Earth's land surface. Such information can be valuable for improving flood models and their calibration; however, SWOT temporal sampling will be limited, with most locations in the world being seen once every 7 to 10 days, which may cause it to miss floods. Using a record of global flood information, including duration and location, compiled by the Dartmouth Flood Observatory and the expected satellite orbit, we estimated that, if already operational, SWOT would have collected at least one measurement over 55% of these events. We illustrate SWOT data coverage using flood inundation maps generated for flooding in eastern Iowa (2008) and in Houston and surrounding areas, Texas, caused by Hurricane Harvey (2017). Due to the novelty of this kind of hydrological information, particularly in the way SWOT samples rivers in time and space, early engagement of potential users may be instrumental to maximize the utility of this open source of worldwide observations of rivers, lakes, and inundated land.
Key Points
SWOT temporal and spatial observation capabilities and limitations are evaluated using recent floods in eastern Iowa and from Hurricane Harvey
During its life cycle, SWOT may observe hundreds of flood events, including over data‐scarce regions
Dartmouth Flood Observatory data suggest that more destructive floods tend to last longer and are more likely to be observed by SWOT
Background: Myofunctional therapy has been shown to be effective in treating sleep-disordered breathing. The elaboration of this protocol arises with the purpose of establishing a complete and common ...evaluation of sleep respiratory disorders from the point of view of the anatomy and functionality of the upper airway to guarantee the long-term treatment of the different phenotypes of patients with obstructive sleep apnoea (OSA).
Our multidisciplinary unit has an experience of more than 10 years in treating OSA patients and has numerous recent publications focused on the role of myofunctional therapy.
Methods: The evaluation of the patient with obstructive sleep apnoea is carried out jointly by the medical team of Pulmonology and Otorhinolaryngology of the Sleep Unit. The patients undergo an anatomical and motor tone evaluation of the upper airway to find the cause of the collapse and a sleep study to confirm the diagnosis and its severity.
Conclusions: With this protocol we want to present our clinical experience in the comprehensive diagnostic management of the patient with obstructive sleep apnea and provide the most correct treatment among the different therapeutic options available for sleep apnea.
Researchers and clinicians frequently use behavioral measures to assess decision making. The most common task that is marketed to clinicians is the Iowa Gambling Task (IGT), thought to assess risky ...decision making. How does performance on the IGT relate to performance on other common measures of decision making? The present study sought to examine relationships between the IGT, the Balloon Analogue Risk Task (BART), and the Columbia Card Task (CCT). Participants were 390 undergraduate students who completed the IGT, BART, and either the "hot" or "cold" CCT. Principal components factor analysis on the IGT, BART, and CCT-cold (n = 112) indicated that the IGT measures a different component of decision making than the BART, and the CCT-cold weakly correlated with early IGT trials. Results of the exploratory factor analysis on the IGT, BART, and CCT-hot (n = 108) revealed a similar picture: the IGT and BART assessed different types of decision making, and the BART and CCT-hot were weakly correlated. A confirmatory factor analysis (n = 170) indicated that a 3-factor model without the CCT-cold (Factor 1: later IGT trials; Factor 2: BART; and Factor 3: early IGT trials) was a better fitting model than one that included the CCT-cold and early IGT trials on the same factor. Collectively, the present results suggest that the IGT, BART, and CCT all measure unique, nonoverlapping decision making processes. Further research is needed to more fully understand the neuropsychological construct of decision making.
Geometric characteristics of the washboard moraines of the Des Moines Lobe (DML) of the Laurentide ice sheet agree with their proposed origin as crevasse-squeeze ridges, but study of their sediments ...is required to help further test this hypothesis. A 70-m-long, 3–5m high section through a moraine ridge in central Iowa revealed till with irregular, isolated lenses of silt, sand, and gravel that dip to varying extents upglacier. The texture and density of the till are like those of the basal till of the DML studied elsewhere in Iowa, and preconsolidation pressures determined from tests on till and silt of the ridge indicate that it developed subglacially rather than at the glacier margin. Preconsolidation pressures additionally demonstrate that pore-water pressures in the bed supported most of the glacier's weight, which would have contributed to till mobility. Fabrics based on the anisotropy of magnetic susceptibility of 3125 intact till specimens collected at 125 locations in the section indicate two end-member states of strain that varied with location in the ridge and caused sediment mounding: simple shear that was directed downglacier along shear planes inclined upglacier, together with pure shear where an overlying crevasse allowed the sediment bed to extend upward and laterally. Meltwater that likely flowed along the crevasse deposited sorted sediments that were incorporated in till, deformed, and rotated. This positive test of the crevasse-squeeze hypothesis indicates that the DML was in longitudinal extension near its margin, reinforcing previous arguments that the lobe surged. The predominance of fabrics caused by simple shear demonstrates that crevasse filling was underway before the surge had fully halted. This study should prompt caution in using similar transverse ridges, such as those geophysically imaged in some submarine glacier forefields, as indicators of retreat rates.
•Sediment properties reveal the origin of a Des Moines Lobe washboard moraine.•Till texture and density are like those of the lobe's basal till studied elsewhere.•Preconsolidation pressures indicate the ridge formed subglacially.•Magnetic fabrics indicate till mounding by shearing and upward extrusion.•The moraine formed as a crevasse-squeeze ridge, indicating surging of the lobe.
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