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Background: White matter hyperintensities (WMH) are associated with impaired cognition and increased falls risk. Resistance training (RT) is a promising intervention to reduce WMH progression, improve executive functions, and reduce falls. However, the underlying neurobiological process by which RT improves executive functions and falls risk remain unclear. We hypothesized that: 1) RT reduces the level of WMH-related disruption to functional networks; and 2) reduced disruption to the sensorimotor and attention networks will be associated with improved executive function and reduced falls risk.Objective: Investigate the impact of 52 weeks of RT on WMH-related disruption to functional networks.Methods: Thirty-two older females (65-75 years) were included in this exploratory analysis of a 52-week randomized controlled trial. Participants received either twice-weekly RT or balance and tone training (control). We used lesion network mapping to assess changes in WMH-related disruption to the sensorimotor, dorsal attention, and ventral attention networks. Executive function was measured using the Stroop Colour-Word Test. Falls risk was assessed using the Physiological Profile Assessment (PPA) and the foam sway test.Results: RT significantly reduced the level of WMH-related disruption to the sensorimotor network (p = 0.012). Reduced disruption to the dorsal attention network was associated with improvements in Stroop performance (r = 0.527, p = 0.030). Reduced disruption to the ventral attention network was associated with reduced PPA score (r = 0.485, p = 0.049)Conclusion:RT may be a promising intervention to mitigate WMH-related disruption to the sensorimotor network. Additionally, reducing disruption to the dorsal and ventral attention networks may contribute to improved executive function and reduced falls risk respectively. [ABSTRACT FROM AUTHOR]

• Lesion network mapping identifies functional networks associated with falls risk • WMH-related disruption to the DAN is associated with greater falls risk • WMH-related disruption to the SMN and VAN are associated with foam sway • Physical activity moderates the association between the DAN and falls risk White matter hyperintensities (WMH) are associated with greater falls risk and slow gait speed. Whether these deficits are caused by the disruption of large-scale functional networks remains inconclusive. Further, physical activity moderates the association between WMHs and falls, but whether this extends to the disruption of functional networks remains unknown. One hundred and sixty-four adults (>55 years old) were included in this study. Using lesion network mapping, we identified significant correlations between the percentage of WMH-related disruption of the dorsal attention network and Physiological Profile Assessment (PPA) score (r = 0.24, p < 0.01); and between disruption of both the sensorimotor (r = 0.23, p < 0.01) and ventral attention networks (r = 0.21, p = 0.01) with foam sway. There were no significant associations with floor sway or gait speed. Physical activity moderated the association between the dorsal attention network and PPA score (p = 0.045). Thus, future research should investigate whether physical activity should be recommended in the clinical management of older adults with cerebral small vessel disease. [ABSTRACT FROM AUTHOR]

Approximately one third of recently diagnosed Parkinson's disease (PD) patients experience cognitive decline. The nucleus basalis of Meynert (NBM) degenerates early in PD and is crucial for cognitive function. The two main NBM white matter pathways include a lateral and medial trajectory. However, research is needed to determine which pathway, if any, are associated with PD-related cognitive decline. Thirty-seven PD patients with no mild cognitive impairment (MCI) were included in this study. Participants either developed MCI at 1-year follow up (PD MCI-Converters; n = 16) or did not (PD no-MCI; n = 21). Mean diffusivity (MD) and fractional anisotropy (FA) of the medial and lateral NBM tracts were extracted using probabilistic tractography. Between-group differences in MD and FA for each tract was compared using ANCOVA, controlling for age, sex, and disease duration. Control comparisons of the internal capsule MD and FA were also performed. Associations between baseline MD or FA and cognitive outcomes (working memory, psychomotor speed, delayed recall, and visuospatial function) were assessed using linear mixed models. PD MCI-Converters had significantly greater MD and lower FA (p <.001) of both NBM tracts compared to PD no-MCI. No difference was found in the MD (p =.06) or FA (p =.31) of the control region. Trends were identified between: 1) lateral tract MD and FA with working memory decline; and 2) medial tract MD and reduced psychomotor speed. Reduced integrity of the NBM tracts is evident in PD patients up to one year prior to the development of MCI. Thus, deterioration of the NBM tracts in PD may be an early marker of those at risk of cognitive decline. • Reduced integrity of cholinergic network up to 1 year prior to cognitive decline. • Cholinergic network deficits in Parkinson's disease-related cognitive impairment. • Tractography of the nucleus basalis of meynert in Parkinson's disease. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the structure of the Essentials of Magnetism II (EOMII) scale using data from nurses working in England; and to describe the impact of different aspects of the nursing work environment on nurse-assessed care quality (NACQ). Background The EOMII Scale was developed in the United States to measure nursing work environments. It has been widely used in the United States and in a number of other countries, but has not yet been used in the UK. Design Cross-sectional study. Methods Registered nurses ( n = 247) providing direct patient care in two National Health Service hospitals in England completed the EOMII scale and a single-item measuring NACQ. Principal components analysis was used to assess the structure of the scale. Correlation and regression analyses were used to describe the relationships between factors and NACQ. Results A solution with explanatory variance of 45.25% was identified. Forty items loaded on five factors, with satisfactory consistency: (i) ward manager support; (ii) working as a team; (iii) concern for patients; (iv) organisational autonomy; and (v) constraints on nursing practice. While in univariate analyses, each of the factors was significantly associated with NACQ, in multivariate analyses, the relationship between organisational autonomy and NACQ no longer reached significance. However, a multiple mediation model indicated that the effect of organisational autonomy on NACQ was mediated by nurse manager support, working as a team and concern for patients but not constraints on nursing practice. Conclusions Subscales of the EOMII identified in an English sample of nurses measured important aspects of the nursing work environment, each of which is related to NACQ. Relevance to clinical practice The EOMII could be a very useful tool for measuring aspects of the nursing work environment in the English Trusts particularly in relation to the quality of care. [ABSTRACT FROM AUTHOR]

There is some evidence for paradoxical effects of nutritional labelling on energy intake particularly amongst restrained eaters and those with a higher body mass index (BMI) resulting in greater consumption of energy from foods with a positive health message (e.g. "low-fat") compared with the same foods, unlabelled. This study aimed to investigate, in a UK general population sample, the likelihood of paradoxical effects of nutritional labelling on energy intake. Participants (n = 287) attended a London cinema and were offered a large tub of salted or toffee popcorn. Participants were randomised to receive their selected flavour with one of three labels: a green low-fat label, a red high-fat label or no label. Participants watched two film clips while completing measures of demographic characteristics, emotional state and taste of the popcorn. Following the experiment, popcorn consumption was measured. There were no main effects of nutritional labelling on consumption. Contrary to predictions neither BMI nor weight concern moderated the effect of label on consumption. There was a three-way interaction between low-fat label, weight concern and socioeconomic status (SES) such that weight-concerned participants of higher SES who saw a low-fat label consumed more than weight unconcerned participants of similar SES (t = -2.7, P = .04). By contrast, weight-concerned participants of lower SES seeing either type of label, consumed less than those seeing no label (t = -2.04, P = .04). Nutritional labelling may have different effects in different socioeconomic groups. Further studies are required to understand fully the possible contribution of food labelling to health inequalities. [ABSTRACT FROM AUTHOR]

Abstract: Gluten-free formulations are often supplemented with proteins to improve their quality. To determine the effects of alternative proteins on a hydroxypropyl methylcellulose (HPMC)-treated gluten-free dough system, soy protein isolate was added at 1%, 2% and 3% while egg white solids were investigated at 5%, 10% and 15%. The formulated doughs were analysed using thermoanalytic and rheological techniques to determine the role of water and subsequent flow behaviour upon hydrocolloid addition. The baked loaves were measured for specific loaf volume and tensile strength to determine bread quality. The addition of soy protein isolate and egg white solids (5% and 10%) reduced dough stability by suppressing HPMC functionality, reducing available water, weakening HPMC interactions with the starch matrix and reducing foam stability. At 15% addition, egg white solids became the primary protein scaffolding in the dough and overcame negative interactions with HPMC, improving the loaf volume. However, this formulation may need further optimisation to meet full consumer acceptability. [Copyright &y& Elsevier]

To better understand the physicochemical changes imparted by hydrocolloids on gluten-free dough, 2 hydroxypropyl methylcelluloses (HPMCs) and xanthan gum were added at 2%, 3%, and 5% to rice cassava dough without the addition of alternative proteins. The formulated doughs were analyzed using thermoanalytic and rheological techniques to determine the role of water and subsequent flow behavior upon hydrocolloid addition. The baked loaves were then measured for specific loaf volume and tensile strength to determine bread quality. Thermogravimetric analysis (TGA) results revealed that hydrocolloid-added dough held water more tightly than the rice cassava control with an additional water distribution at 85 to 88 °C. Rheologically, the increase of elastic moduli in the low methoxy HPMC and xanthan-added dough became more pronounced with gum addition; however, both HPMC formulations had increased viscous moduli allowing the gas cells to expand without collapsing. In the bread, the final specific loaf volume increased with high methoxy HPMC (2% to 5%) and low methoxy HPMC (2%) but was depressed with increased addition of low methoxy HPMC (5%) and xanthan (3% and 5%). Crumb hardness was decreased in high methoxy HPMC loaves but was increased significantly in low methoxy HPMC (5%) and xanthan (5%) formulations. From the gums studied, it was concluded that high methoxy HPMC was the optimum hydrocolloid in the rice cassava gluten-free dough. Two types of hydrocolloids, xanthan gum and HPMC, were individually added to a gluten-free rice cassava formulation. Based on the thermoanalytic and rheological studies on dough, as well as the bread quality studies, high methoxy HPMC at 5% addition was determined to optimally improve the bread quality when only gum addition was considered. This study indicates the potential use of high methoxy HPMC as an additive in gluten-free bread formulations prior to considering alternative proteins. [ABSTRACT FROM AUTHOR]

Flagellar synchronisation has been observed between bull spermatozoa as they swam in a viscous medium, confined to a glass surface. This process is of interest in understanding the regulation of flagellar oscillation in general. Exact and persisting synchrony between bull spermatozoa occurred only when the spermatozoan heads were tightly coupled mechanically. For these cells, viscous coupling between the flagella was not by itself sufficient to establish synchronisation. Immediately on synchronisation, with the spermatozoan heads superposed, the paired spermatozoa showed rises in conjoint beat frequency, wave velocity and swimming velocity, i.e. in nearly all cases, the new conjoint values were greater than those shown by either of the two singleton spermatozoa. In our interpretation of these results, we put forward hydrodynamic arguments for seeing the primary change as a rise in wave velocity, via a decreased viscous resistance to bend propagation. Mechanistically, the rise in beat frequency is mysterious unless, as we suggest, it is consequential to the rise in wave velocity, and mediated by an as-yet- unknown mechanical feedback process. The rise in swimming velocity is not surprising given the rise in wave velocity but there is evidence for an additional influence due to a subtle re-orientation of the conjoint spermatozoan heads, such that they experienced less frictional drag. [ABSTRACT FROM AUTHOR]

Research on health behaviour and time orientation has been hindered by a lack of consensus about appropriate measurement. Study 1 assessed the reliability of the Consideration of Future Consequences Scale (CFC) and the Zimbardo Time Perspective Inventory (ZTPI) in a general population sample (n = 300). Although more reliable, the CFC was less readable. Study 2 assessed the validity of a shortened ZTPI, measuring future and present orientation, and the full CFC. The measures had good discrimination to distinguish interpersonal differences. Construct validity of present, but not future, orientation as measured by the ZTPI, was evidenced by its mediation of the association between socioeconomic status and expectations of participating in diabetes screening. The CFC mediated this relationship more weakly. Further investigation of present orientation in understanding health-related behaviour is warranted. [ABSTRACT FROM AUTHOR]

Checking patient understanding, by asking questions about information presented in a medical consultation, is a core communication skill but its use is not frequently assessed. The newborn hearing screening commenced in England with a pilot of its implementation in January 2002. Because it is a new screening test, it provided an opportunity for studying the effective communication of novel information. A randomized controlled trial of training newborn hearing screeners to present information about the screening test and to ask questions to check understanding was commenced but had to be prematurely ended as the majority of the screeners did not ask the questions. The aim of this study was to understand why the screeners did not ask questions to check understanding of the information provided. Questionnaires were sent to screeners who participated in the study to elicit their responses to the use of the questions to check understanding. A response rate of 87% (26/30) was achieved. Screeners who reported not asking the questions were more likely to express a lack of confidence in their ability to ask questions, and to perceive asking questions as an ineffective way of increasing patient understanding. The study suggests that the ability and willingness of healthcare professionals to use simple communication skills may have been overestimated and training needs to target skills as well as beliefs about the effectiveness of using them. [ABSTRACT FROM AUTHOR]

Objectives: To describe the impact upon maternal anxiety of newborn hearing screening and examine the Possible moderating role of knowledge. Methods: Questionnaires assessing maternal state anxiety, worry and certainty about the baby's hearing, and knowledge about screening, were sent to four groups of mothers three weeks after screening: Group 1 consisted of mothers whose babies had clear responses on a first or second screening test (n=103); Group 2 consisted of mothers whose babies had clear responses on the third screening test (n=81); Group 3 consisted of mothers whose babies did not have clear responses in one ear at the third screening test and were referred for audiological assessment (n=105); and Group 4 consisted of mothers whose babies did not have clear responses in either ear at the third hearing test and were referred for audiological assessment (n=55). Results: Although mean anxiety levels were in the normal range, there was a significant trend for anxiety to rise as testing increased (F(1,327)=4.280, P<0.05). Worry increased significantly (F(1,337)=70.432, P<0.001) and certainty decreased significantly (F(1,339)=27.474, P=0.001) as the number of tests increased. Although total knowledge did not significantly moderate anxiety (R2=0.016, P=0.096), there was a significant interaction between mothers' group and one knowledge item, understanding that receipt of no clear responses was unlikely to mean that the baby had a hearing loss: mothers in Group 4 who understood this had lower anxiety (F(3,323)=4.791, P<0.01) and lower worry (F(3,332)=3.565, P<0.01) compared with mothers who did not. Conclusions: Understanding the meaning of being recalled following screening may avoid some of the anxiety associated with this. [ABSTRACT FROM AUTHOR]

Background: Newborn hearing screening is currently replacing the health visitor distraction test (HVDT) conducted at eight months. Our previous research indicates that recall for further tests following newborn hearing screening can have a negative impact on the emotional well being of mothers, but it is not known if this is greater than that caused by recall following the distraction test. Objective: To compare the impact on maternal anxiety and satisfaction of recall following newborn hearing screening and the HVDT. Methods: Four groups participated: 27 mothers of babies receiving a satisfactory result and 21 mothers of babies recalled after the HVDT 26 mothers of babies receiving a satisfactory result and 16 mothers of babies recalled after newborn hearing screening. Questionnaires assessing maternal anxiety, worry and certainty about the babies' hearing, satisfaction with and attitudes towards the screening test were sent to mothers three weeks and six months following screening. Results: Comparison of the effects of receipt of different results showed no significant differences in maternal anxiety, worry and certainty between the two tests. Those mothers whose babies had a newborn hearing screening test were significantly more satisfied, regardless of the result received. Those who received a satisfactory result on the newborn hearing screening programme also had more positive attitudes towards that screening test than those receiving a satisfactory result following the HVDT. Conclusion: These results suggest that newborn hearing screening does not have a more negative emotional impact than the HVDT. [ABSTRACT FROM AUTHOR]

White matter hyperintensities (WMH) are a prominent feature of cerebral small vessel disease and are associated with cognitive impairment. These deficits in cognition may be caused by the disruption of large-scale functional networks due to the presence of WMHs. However, knowledge regarding the relevance of these lesions on functional networks remains inconclusive. These inconsistencies may derive from issues with interpreting functional imaging data from clinical populations. Lesion network mapping is a technique that allows the overlaying of lesions from a patient population to the functional connectivity of a human connectome derived from healthy adults. This allows researchers to identify functional networks that would be disrupted in a healthy population should the WMHs seen in cerebral small vessel disease be present. We hypothesized that the extent to which these functional networks are disrupted by WMHs is associated with cognitive performance in older adults with cerebral small vessel disease. This cross-sectional study combined baseline data from four studies to create a total sample of 164 older adults (aged ≥55) from metropolitan Vancouver with cerebral small vessel disease. Using lesion network mapping, we assessed the percentage overlap between voxels functionally connected with both the WMHs (lesion network) and five common functional networks: (1) visual; (2) dorsal attention; (3) ventral attention; (4) sensorimotor; and (5) frontoparietal. Cognition was assessed using: (1) Montreal Cognitive Assessment (MoCA); (2) Stroop Colour Word Test (3–2); (3) Trail Making Tests (Part B-A); and (4) Digit Symbol Substitution Test. A One-Way ANOVA and Tukey post-hoc tests were performed to identify the functional networks with greatest percentage overlap with the lesion network. Partial correlations controlling for age were used to analyse whether the extent of the overlap between the lesion and functional networks was associated with poorer cognition. The visual, ventral attention, and frontoparietal networks had significantly greater overlap with the lesion network. After controlling for multiple comparisons, level of lesion network overlap with both the sensorimotor network (p<.001) and ventral attention network (p <. 001) was significantly correlated with MoCA score. Thus, the greater the disruption to the sensorimotor and ventral attention networks, the poorer the global cognition. Our results reveal that the visual, ventral attention, and frontoparietal networks are most vulnerable to disruptions stemming from WMHs. Additionally, we identified that disruption to the sensorimotor and ventral attention networks, as a result of WMHs, may underlie deficits in global cognition in older adults with cerebral small vessel disease. [ABSTRACT FROM AUTHOR]

Subtle changes in mobility exist among older adults with mild cognitive impairment (MCI). Life-space mobility defines the frequency and extent of movements in the environment, and lower life-space mobility is associated with adverse health outcomes and MCI. Currently, the underlying mechanism of this association is not well understood. This study examined the functional neural correlates of life-space mobility in community-dwelling older adults with MCI. We first conducted a cross-sectional investigation of the association between resting-state default mode network (DMN) and sensori-motor network (SMN) connectivity and life-space mobility (assessed by the Life-Space Assessment (LSA)) among 60 community-dwelling older adults with MCI using aggregated data from two studies – baseline data from a randomized controlled trial (n = 20) and baseline data from a 12-month prospective study (n = 40). Using data from the 12-month prospective study (n = 35), we then examined whether baseline internetwork connectivity predicts reduced life-space mobility over 12 months. The cross-sectional analysis showed higher DMN-SMN connectivity was associated with lower LSA scores after adjusting for baseline global cognitive function and baseline age (p < 0.01). A significant reduction in LSA scores was observed in the 35 participants of the 12-month prospective study (paired sample t -test mean change = −6.53, p = 0.01). Greater baseline DMN-SMN connectivity was associated with greater reduction in life-space mobility at 12 months (p = 0.04) after adjusting for baseline age, global cognitive function, and LSA score. Our findings suggest that lower and reduced life-space mobility in older adults with MCI may be due to altered functional architecture of the brain such that normal neuro-cognitive motor behaviours may be disrupted. [ABSTRACT FROM AUTHOR]

• Fallers with MCI had a greater level of disruptive DMN-SMN connectivity. • DMN-SMN connectivity increased linearly from Fallers only – MCI only – Fallers + MCI. • Fallers with MCI have significantly greater postural sway than those without MCI. • Postural sway increased linearly from Fallers only - MCI only - Fallers + MCI. Disrupted functional connectivity has been highlighted as a neural mechanism by which impaired cognitive function and mobility co-exist in older adults with mild cognitive impairment (MCI). The objective of this study was to determine the independent and combined effects of MCI and faller status on functional connectivity of three functional networks: default mode network (DMN), fronto-parietal network (FPN) and sensorimotor network (SMN) between 4 groups of older adults: 1) Healthy; 2) MCI without Falls; 3) Fallers without MCI; and 4) Fallers with MCI. Sixty-six adults aged 70–80 years old were included. Cognition was assessed using: 1) cognitive dual task; 2) Stroop Colour-Word Test; 3) Trail Making Tests (TMT); and 4) Digit Symbol Substitution Test (DSST). Postural sway was assessed with eyes opened and standing on the floor. Functional connectivity was measured using fMRI while performing a finger-tapping task. Differences in DMN-SMN connectivity were found for Fallers with MCI vs Fallers without MCI (p =.001). Fallers with MCI had significantly greater postural sway than the other groups. Both DMN-SMN connectivity (p =.03) and postural sway (p =.001) increased in a significantly linear fashion from Fallers without MCI, to MCI without Falls, to Fallers with MCI. Participants with MCI performed significantly worse on the DSST (p =.003) and TMT (p =.007) than those without MCI. Aberrant DMN-SMN connectivity may underlie reduced postural stability. Having both impaired cognition and mobility is associated with a greater level of disruptive DMN-SMN connectivity and increased postural sway than singular impairment. [ABSTRACT FROM AUTHOR]

Background: Subcortical ischemic vascular cognitive impairment (SIVCI) is the most common form of vascular cognitive impairment. Importantly, SIVCI is considered the most treatable form of cognitive impairment in older adults, due to its modifiable risk factors such as hypertension, diabetes mellitus, and hypercholesterolemia. Exercise training is a promising intervention to delay the progression of SIVCI, as it actively targets these cardiometabolic risk factors. Despite the demonstrated benefits of resistance training on cognitive function and emerging evidence suggesting resistance training may reduce the progression of white matter hyperintensities (WMHs), research on SIVCI has predominantly focused on the use of aerobic exercise. Thus, the primary aim of this proof-of-concept randomized controlled trial is to investigate the efficacy of a 12-month, twice-weekly progressive resistance training program on cognitive function and WMH progression in adults with SIVCI. We will also assess the efficiency of the intervention.Methods: Eighty-eight community-dwelling adults, aged > 55 years, with SIVCI from metropolitan Vancouver will be recruited to participate in this study. SIVCI will be determined by the presence of cognitive impairment (Montreal Cognitive Assessment < 26) and cerebral small vessel disease using computed tomography or magnetic resonance imaging. Participants will be randomly allocated to a twice-weekly exercise program of (1) progressive resistance training or (2) balance and tone training (i.e., active control). The primary outcomes are cognitive function measured by the Alzheimer's Disease Assessment Scale-Cognitive-Plus (ADAS-Cog-13 with additional cognitive tests) and WMH progression.Discussion: The burden of SIVCI is immense, and to our knowledge, this will be the first study to quantify the effect of progressive resistance training on cognitive function and WMH progression among adults with SIVCI. Slowing the rate of cognitive decline and WMH progression could preserve functional independence and quality of life. This could lead to reduced health care costs and avoidance of early institutional care.Trial Registration: ClinicalTrials.gov NCT02669394 . Registered on February 1, 2016. [ABSTRACT FROM AUTHOR]

Background: Targeted exercise training is a promising strategy for promoting cognitive function and preventing dementia in older age. Despite the utility of exercise as an intervention, variation still exists in exercise-induced cognitive gains and questions remain regarding the type of training (i.e., what), as well as moderators (i.e., for whom) and mechanisms (i.e., how) of benefit. Both aerobic training (AT) and resistance training (RT) enhance cognitive function in older adults without cognitive impairment; however, the vast majority of trials have focused exclusively on AT. Thus, more research is needed on RT, as well as on the combination of AT and RT, in older adults with mild cognitive impairment (MCI), a prodromal stage of dementia. Therefore, we aim to conduct a 6-month, 2 × 2 factorial randomized controlled trial in older adults with MCI to assess the individual effects of AT and RT, and the combined effect of AT and RT on cognitive function and to determine the possible underlying biological mechanisms.Methods: Two hundred and sixteen community-dwelling adults, aged 65 to 85 years, with MCI from metropolitan Vancouver will be recruited to participate in this study. Randomization will be stratified by biological sex and participants will be randomly allocated to one of the four experimental groups: (1) 4×/week balance and tone (BAT; i.e., active control); (2) combined 2×/week AT + 2×/week RT; (3) 2×/week AT + 2×/week BAT; or (4) 2×/week RT + 2×/week BAT. The primary outcome is cognitive function as measured by the Alzheimer's Disease Assessment Scale-Cognitive-Plus. Secondary outcomes include cognitive function, health-related quality of life, physical function, actigraphy measures, questionnaires, and falls. Outcomes will be measured at baseline, 6 months (i.e., trial completion), and 18 months (i.e., 12-month follow-up).Discussion: Establishing the efficacy of different types and combinations of exercise training to minimize cognitive decline will advance our ability to prescribe exercise as "medicine" to treat MCI and delay the onset and progression of dementia. This trial is extremely timely as cognitive impairment and dementia pose a growing threat to global public health.Trial Registration: ClinicalTrials.gov NCT02737878 . Registered on April 14, 2016. [ABSTRACT FROM AUTHOR]

Objective: Little research has been conducted on consumer perceptions of alcohol packaging as a marketing tool. The aim of this study was to explore how young adults view and engage with alcohol packaging. Method: Eight focus groups were conducted in Glasgow (Scotland) with current drinkers (n = 50), segmented by age (18-24, 25-35), gender (female, male), and social grade (ABC1, C2DE). Participants were shown, allowed to handle, and asked about a range of alcoholic products. Results: Five main themes emerged from the data. The first was the ubiquity of alcohol packaging, with frequent exposure reported in different settings, such as shops and drinking venues, and via marketing. The second was appeal, with pack graphics (e.g., color), structure (e.g., shape, size), and promotions (e.g., gifts, limited editions) allowing alcohol packs to catch attention, enabling products to stand out on shelves, and helping to create product and brand liking, interest, and choice. Third, alcohol packaging was frequently associated with specific occasions and activities. Fourth, alcohol packaging informed perceptions of product-consumer targeting, suitability, and intended drinker profiles. Fifth, alcohol packaging also engaged nonvisual senses (e.g., touch, sound, smell), guiding expectations of product taste and palatability. Conclusions: For young adult drinkers in Scotland, alcohol packaging can capture attention, create appeal, and help shape perceptions of the product, drinker, and drinking experience. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol packaging is a potentially valuable means of communicating product and health‐related information, with growing academic and political interest in its role as a health communications vehicle. Methods: An online cross‐sectional survey and experiment were conducted with a non‐probability sample of 18–35‐year‐old drinkers in the United Kingdom (n = 1360). The survey assessed exposure to, and engagement with, current messaging on packs, and support for displaying product and health‐related information. For the randomised experiment, participants were shown, and asked questions about, a vodka bottle with either no warnings (control), small text warnings, large text warnings or pictorial (image‐and‐text) warnings; the main binary outcome measures were negative product appeal and social acceptability, and positive cognitive and behavioural impact. Results: Two‐fifths of the sample rarely or never saw on‐pack health‐related information, with almost three‐quarters rarely or never reading or looking closely at this. There was strong support for displaying a range of product and health‐related information (e.g. units, ingredients) on packs. Relative to the control, products with warnings were more likely to be perceived as unappealing and socially unacceptable, and to positively impact alcohol‐related cognitions and behaviours. For example, pictorial warnings were 10 times as likely to positively influence cognitions and behaviours (AOR = 10.01, 95% CI: 8.09, 17.46). Discussion and Conclusions: Alcohol packaging could have an important role in delivering health messaging. Large pictorial or text warnings may help counteract the appeal and social acceptability of alcohol products and increase awareness of risks, potentially supporting a reduction in consumption and related harms. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol packaging can communicate alcohol-related health information, messaging and warnings. However, there is a dearth of research exploring awareness of, and engagement with, health information and messaging on alcohol packaging, and response to novel alcohol warnings. Methods: Eight focus groups were conducted in Glasgow (Scotland) with current drinkers (n=50), segmented by age (18-24, 25-35), gender (female, male) and social grade (ABC1, C2DE), to explore awareness and use of health information and messaging on existing packaging, and perceptions of novel front-of-package warnings differing in size (small, large), form (text-only, text and image) and message content (general, specific). Results: Unaided recall of some health information and messaging was high (e.g. units, pregnancy symbols); however, most participants did not attend to or meaningfully engage with these, viewing them as unnoticeable, obscure and ineffective. Participants were skeptical of alcohol companies' motivations with respect to health messaging on products. They were surprised to see the novel warnings on alcohol products but generally supported their inclusion. Most thought that these warnings could increase awareness of alcohol-related harms, particularly for younger or potential drinkers. Large, combined (text and image) warnings with specific messages on the front of packaging were considered most engaging and potentially effective. Conclusions: The health-related information and messaging on alcohol packaging in Scotland is failing to inform consumers about the potential risks associated with alcohol use. Prominent warnings on alcohol packaging could help to capture attention, increase awareness of alcohol-related harms, and may support a reduction in consumption and alcohol-related harms. [ABSTRACT FROM AUTHOR]

Background: Myelin damage is a salient feature in cerebral small vessel disease (cSVD). Of note, myelin damage extends into the normal appearing white matter (NAWM). Currently, the specific role of myelin content in cognition is poorly understood.Objective: The objective of this exploratory study was to investigate the association between NAWM myelin and cognitive function in older adults with cSVD.Methods: This exploratory study included 55 participants with cSVD. NAWM myelin was measured using myelin water imaging and was quantified as myelin water fraction (MWF). Assessment of cognitive function included processing speed (Trail Making Test Part A), set shifting (Trail Making Test Part B minus A), working memory (Verbal Digit Span Backwards Test), and inhibition (Stroop Test). Multiple linear regression analyses assessed the contribution of NAWM MWF on cognitive outcomes controlling for age, education, and total white matter hyperintensity volume. The overall alpha was set at ≤0.05.Results: After accounting for age, education, and total white matter hyperintensity volume, lower NAWM MWF was significantly associated with slower processing speed (β  = -0.29, p = 0.037) and poorer working memory (β= 0.30, p = 0.048). NAWM MWF was not significantly associated with set shifting or inhibitory control (p > 0.132).Conclusion: Myelin loss in NAWM may play a role in the evolution of impaired processing speed and working memory in people with cSVD. Future studies, with a longitudinal design and larger sample sizes, are needed to fully elucidate the role of myelin as a potential biomarker for cognitive function. [ABSTRACT FROM AUTHOR]

Background: Professional autonomy is a key concept in understanding nurses' roles in delivering patient care. Recent research exploring the role of autonomy in the nursing work environment indicated that English and American nurses had differing perceptions of autonomy. This qualitative study aimed to explore the understanding and experiences of autonomy of nurses working in England. Methods: A descriptive phenomenological analysis of data from 48 semi-structured interviews with registered nurses from two National Health Service (NHS) hospitals (purposive sample) was used to explore the concept of autonomy. Results: Six themes were identified: working independently; working in a team; having professional skills and knowledge; involvement in autonomy; boundaries around autonomy; and developing autonomy requires support. A key finding was that nurses related autonomy to their clinical work and to the immediate work environment of their ward, rather than to a wider professional context. Nurses also perceived that autonomy could be turned off and on rather than comprising an integrated aspect of nursing. Conclusions: Findings suggest that nurses in England, as framed by the sample, had a local ward-focused view of autonomy in comparison to nurses in America, who were reported to relate autonomy to a wider involvement in hospital level committees. Findings further indicate that autonomy was practiced occasionally, rather than incorporated into practice. Findings highlight the need for nurses in England to adopt a broader perspective and actively contribute to writing hospital guidelines and policies that recognise the importance of autonomy to nurse training and practice. [ABSTRACT FROM AUTHOR]

Exercise plays a key role in healthy aging by promoting both physical and cognitive function. Physical function and cognitive function appear to be interrelated and may share common mechanisms. Thus, exercise-induced improvements in physical function and cognitive function may co-occur and be associated with each other. However, no systematic review has specifically assessed and compared the effects of exercise on both physical function and cognitive function in older adults, and the association between changes in both outcomes after exercise training. Thus, we conducted a systematic review and meta-analysis (N = 48 studies) among older adults (60+ years). These data suggest exercise training has a significant benefit for both physical function (g = 0.39; p < 0.001) and cognitive function (g = 0.24; p < 0.001). At the study level, there was a positive correlation between the size of the exercise-induced effect on physical function and on cognitive function (b = 0.41; p = 0.002). Our results indicate exercise improves both physical and cognitive function, reiterating the notion that exercise is a panacea for aging well. • Maintaining physical and cognitive function is critical for healthy aging. • Physical function and cognitive function are linked and share common mechanisms. • Exercise training improves physical function and cognitive function. • Exercise-induced improvements in physical and cognitive function are associated. [ABSTRACT FROM AUTHOR]

Background: The behavioural impact of pharmacogenomics is untested; informing smokers of genetic test results for responsiveness to smoking cessation medication may increase adherence to this medication. The objective of this trial is to estimate the impact upon adherence to nicotine replacement therapy (NRT) of informing smokers that their oral dose of NRT has been tailored to a DNA analysis. Hypotheses to be tested are as follows: I Adherence to NRT is greater among smokers informed that their oral dose of NRT is tailored to an analysis of DNA (genotype), compared to one tailored to nicotine dependence questionnaire score (phenotype). II Amongst smokers who fail to quit at six months, motivation to make another quit attempt is lower when informed that their oral dose of NRT was tailored to genotype rather than phenotype. Methods/Design: An open label, parallel groups randomised trial in which 630 adult smokers (smoking 10 or more cigarettes daily) using National Health Service (NHS) stop smoking services in primary care are randomly allocated to one of two groups: i. NRT oral dose tailored by DNA analysis (OPRM1 gene) (genotype), or ii. NRT oral dose tailored by nicotine dependence questionnaire score (phenotype) The primary outcome is proportion of prescribed NRT consumed in the first 28 days following an initial quit attempt, with the secondary outcome being motivation to make another quit attempt, amongst smokers not abstinent at six months. Other outcomes include adherence to NRT in the first seven days and biochemically validated smoking abstinence at six months. The primary outcome will be collected on 630 smokers allowing sufficient power to detect a 7.5% difference in mean proportion of NRT consumed using a two-tailed test at the 5% level of significance between groups. The proportion of all NRT consumed in the first four weeks of quitting will be compared between arms using an independent samples t-test and by estimating the 95% confidence interval for observed between-arm difference in mean NRT consumption (Hypothesis I). Motivation to make another quit attempt will be compared between arms in those failing to quit by six months (Hypothesis II). Discussion: This is the first clinical trial evaluating the behavioural impact on adherence of prescribing medication using genetic rather than phenotypic information. Specific issues regarding the choice of design for trials of interventions of this kind are discussed. Trial details: Funder: Medical Research Council (MRC) [ABSTRACT FROM AUTHOR]