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Background and purpose: Amyotrophic lateral sclerosis (ALS) is increasingly recognized as a multisystem disorder with 30%–50% of patients exhibiting cognitive impairment. The pathophysiological mechanisms of cognitive dysfunction are probably multifactorial although hypoventilation secondary to respiratory dysfunction may contribute to cognitive decline. The current study aimed to identify the relationship between respiratory function in ALS patients and the presence and degree of cognitive impairment. Methods: Amyotrophic lateral sclerosis patients were prospectively recruited from a multidisciplinary ALS clinic. Baseline clinical assessments including respiratory function as assessed by spirometry were recorded with forced vital capacity (FVC) ≤ 75% considered to be reduced respiratory function. Cognitive testing was performed utilizing the Addenbrooke's Cognitive Examination (ACE) and the Mini‐Mental State Examination (MMSE). Results: From a cohort of 100 ALS patients, 48% were categorized as having impaired respiratory function (FVC = 58.24% ± 2.15%) whilst 52% had normal function (88.65% ± 1.27%). Compared to the group with normal respiratory function (ACE 90.68 ± 0.89, MMSE 28.22 ± 0.21), patients with respiratory dysfunction had significantly reduced cognitive function (ACE 86.83 ± 1.5, P = 0.025; MMSE 26.29 ± 0.45, P = 0.029). Furthermore, subscores demonstrated significant differences between the groups with respect to domains in memory (P = 0.003) and attention (P = 0.05) with a trend observed in fluency (P = 0.082). There was a significant correlation between patient baseline FVC and ACE scores as well as between FVC and memory and fluency subscores (P < 0.01). Conclusion: Amyotrophic lateral sclerosis patients with respiratory compromise were more likely to develop reduced cognitive function. In addition to improving physical function, it remains plausible that non‐invasive ventilation may alter the progression of cognitive impairment in ALS patients and potentially improve overall quality of life and carer burden. [ABSTRACT FROM AUTHOR]

Objective: Rheumatology has previously been a less attractive career choice than other internal medicine (IM) subspecialties. Recent fellowship data from the National Resident Matching Program (NRMP) has suggested that this may have changed. Therefore, we evaluated the current attractiveness of rheumatology as a career choice and compared it with other medical subspecialties.Methods: Data from the NRMP from 2008 to 2017, the 2015 American College of Rheumatology workforce study, and Medscape physician salaries from 2010 to 2017 were used to determine annual numbers of fellowship applicants, availability of positions, and post-fellowship salary trends. Data from 2008 to 2013 were compared with those from 2014 to 2017, and rheumatology was compared with other IM subspecialties.Results: The total number of annual fellowship applicants to rheumatology for 2008-2013 decreased by 3% (average annual mean ± SEM percentage change of -1.9 ± 2.6%), from 251 to 244 applicants. However, for 2014-2017, annual rheumatology applications increased by 44% (average annual mean ± SEM percentage change of 20.7 ± 10.5% [P = 0.03]), from 230 to 332 applicants. Other nonprocedural and procedural IM subspecialties did not exhibit a similar increase. For rheumatology, the increases in the ratio of annual applicants to positions (P = 0.02) and in the percentage of US medical graduates applying (P = 0.03) were statistically significant, and mean post-fellowship salary also rose.Conclusion: The aforementioned observations suggest that rheumatology has become a more attractive career choice since 2014. We speculate that the increasing popularity of the field is multifactorial, likely reflecting lifestyle, job satisfaction and availability, influence of mentors, and other elements. This salutary and exciting potential opportunity for rheumatology should be exploited. [ABSTRACT FROM AUTHOR]

Motor neuron disease ( MND) is characterised by progressive neurological deterioration and coexistence of upper and lower motor neuron signs. Over the past decade, evidence has emerged of unique pathophysiological processes, including glutamate-mediated excitotoxicity, which has resulted in the development of novel diagnostic investigations and uncovered potential therapeutic targets. Advances in genetics, including the recently discovered C9orf72 gene, have radically changed the pathological mindset, from MND being classified as a neuromuscular disease to one that MND forms a continuum with other primary neurodegenerative disorders, including frontotemporal dementia. The present review will highlight the improvements that have occurred in clinical care, in conjunction with recent scientific developments. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to determine whether there is a difference in delayed healing following dental extractions for Type 2 diabetics on oral hypoglycaemics and non-diabetic patients. Methods Prospective patients referred for dental extractions were recruited into two groups: known diabetics and non-diabetics with no conditions associated with poor healing. All had a random blood glucose level ( BGL). Extractions were performed using local anaesthesia. Delayed healing cases were identified and statistical evaluation performed to identify risk factors. Results There were 224 Type 2 diabetics on oral hypoglycaemics ( BGL 7.51, range 4.1-17.4) and 232 non-diabetics. The diabetic group were older, more males and less smokers than the control group. Twenty-eight patients, 12 (5%) diabetic and 16 (7%) control group, had socket healing delayed for more than one week but all healed in four weeks. There were no statistical differences between delayed healing and age, gender, diabetic state, BGL or smoking. The younger control group had more healing problems. Conclusions The traditional view that diabetics have increased delayed healing was not supported. Type 2 diabetics on oral hypoglycaemics should be treated the same as non-diabetic patients for extractions. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented related to the case of a 19-year-old obese female with spontaneous compartment syndrome (SCS) and severe peroneal nerve palsy.

Background: Recruitment and retention of dentists in the public sector and rural areas in Victoria has become increasingly difficult in recent years. There are little available data on the factors that influence the sector and location of practice of new dental graduates. The objective of this study was to investigate the factors considered by new graduates in determining the location and sector of employment after graduation, and influencing any early changes in career path.Methods: Questionnaires were sent to dentists who Mgraduated from The Univrersity of Melbourne from graduated from The University of Melbourne from 2000-2003 who were currently practising in Victoria. There were 154 subjects to whom questionnaires were sent and 109 useable questionnaires were returned, a response rate of 74 per cent.Results: Upon graduation, 53 per cent of the new graduates chose to work in the private sector only, compared to 15 per cent in public sector only and 33 per cent in both. At present, 71 per cent work in the private sector only, 17 per cent in the public sector only and 12 per cent in both. The most important factors for choosing to work in the private sector were receiving broad range of clinical experience, opportunities to familiarize with practice management and providing a continuity of care. The principal factors for practising in the public sector were clinical mentoring and advice, consolidating clinical skills and work environment. Initially, 48 per cent of the sample chose to work in metropolitan areas only, 39 per cent in rural areas only and 13 per cent in both. Factors that influenced the decision to work in rural areas were the broad range of clinical experience and remuneration, while the main factors for choosing to work in metropolitan areas were lifestyle and proximity to family and friends.Conclusions: This study found that a large proportion of new dental graduates initially chose to work in the public sector and rural areas on graduation primarily as a means of consolidating their clinical skills. However, retention of dentists in both these areas appears to be a problem, with less than 10 per cent of 2000-2001 graduates still than 10 per cent of 2000-2001 graduates still working in the public sector and only 20 per cent of 2000-2001 graduates still working in rural areas. [ABSTRACT FROM AUTHOR]

Background: While assessment of subcontractors' safety performance during project bidding processes are common in commercial construction, the validation of organizational surveys used in these processes is largely absent., Methods: As part of a larger research project called Assessment of Contractor Safety (ACES), we designed and tested through a cross-sectional study, a 63-item organizational survey assessing subcontractors' leading indicators of safety performance. We administered the ACES Survey to 43 subcontractors on 24 construction sites. Concurrently, we captured the safety climate of 1426 workers on these sites through worker surveys, as well as injury rates, for the duration of the project., Results: At the worksite level, higher average ACES scores were associated with higher worker safety climate scores (P < .01) and lower rates of injury involving days away (P < .001). Within subcontracting companies, no associations were observed between ACES and worker safety climate scores and injuries., Conclusions: These results suggest the overall and collective importance of the construction project and its worksite in mediating worker experiences, perhaps somewhat independent of the individual subcontractor level., (© 2020 Wiley Periodicals LLC.)