Search

Various terms used in sport and exercise science, and medicine, are derived from other fields such as epidemiology, pharmacology and causal inference. Conceptual and nomological frameworks have described training load as a multidimensional construct manifested by two causally related subdimensions: external and internal training load. In this article, we explain how the concepts of training load and its subdimensions can be aligned to classifications used in occupational medicine and epidemiology, where exposure can also be differentiated into external and internal dose. The meanings of terms used in epidemiology such as exposure, external dose, internal dose and dose–response are therefore explored from a causal perspective and their underlying concepts are contextualised to the physical training process. We also explain how these concepts can assist in the validation process of training load measures. Specifically, to optimise training (i.e. within a causal context), a measure of exposure should be reflective of the mediating mechanisms of the primary outcome. Additionally, understanding the difference between intermediate and surrogate outcomes allows for the correct investigation of the effects of exposure measures and their interpretation in research and applied settings. Finally, whilst the dose–response relationship can provide evidence of the validity of a measure, conceptual and computational differentiation between causal (explanatory) and non-causal (descriptive and predictive) dose–response relationships is needed. Regardless of how sophisticated or “advanced” a training load measure (and metric) appears, in a causal context, if it cannot be connected to a plausible mediator of a relevant response (outcome), it is likely of little use in practice to support and optimise the training process.

MARSSI (Momentary Affect Regulation – Safer Sex Intervention) is a counseling-plus-mobile health (mhealth) intervention to reduce sexual and reproductive health (SRH) risks for women with depression and high-risk sexual behavior. Due to the COVID-19 pandemic limiting in-person care, we sought to develop the counseling and mhealth app onboarding for virtual implementation. A team with SRH, adolescent medicine, motivational interviewing, cognitive behavioral therapy, and technology expertise adapted the counseling through an iterative consensus process. We identified essential aspects of the counseling, specified the content so the counseling could be delivered in person or virtually with fidelity, and considered best practices for telehealth for the focus population. Virtual counseling retained key elements from in-person counseling while including enhancements with engaging visual and audio–video aids. Instructions and programming were developed to support virtual counseling delivery and onboarding for the mhealth app component of MARSSI. After testing the virtual format in mock sessions, we implemented a small-scale feasibility study in an adolescent medicine clinic with women with depressive symptoms and high-risk sexual behavior age 18–24 years (N = 9). Participants experienced minimal technical difficulties and expressed satisfaction with the virtual format, and all were able to complete app onboarding successfully. Expanding delivery options for SRH interventions to include virtual can improve access, particularly for populations with psychological and environmental barriers to care.

This study aimed to investigate the trajectories of spinal pain frequency from 6 to 17 years of age and describe the prevalence and frequency of spinal pain and related diagnoses in children following different pain trajectories. First through fifth-grade students from 13 primary schools were followed for 5.5 years. Occurrences of spinal pain were reported weekly via text messages. Children reporting spinal pain were physically evaluated and classified using International Classification of Disease criteria. Trajectories of spinal pain frequency were modeled from age 6 to 17 years with latent class growth analysis. We included data from 1556 children (52.4% female, mean (SD) baseline age = 9.1 (1.9) years) and identified 10,554 weeks of spinal pain in 329,756 weeks of observation. Sixty-three percent of children reported one or more occurrences of spinal pain. We identified five trajectories of spinal pain frequency. Half the children (49.8%) were classified as members of a "no pain" trajectory. The remaining children followed "rare" (27.9%), "rare, increasing" (14.5%), "moderate, increasing" (6.5%), or "early-onset, decreasing" (1.3%) spinal pain trajectories. The most common diagnoses in all trajectory groups were non-specific (e.g., "back pain"). Tissue-specific diagnoses (e.g., muscle strain) were less common and pathologies (e.g., fracture) were rare. Conclusion: From childhood through adolescence, spinal pain was common and followed heterogeneous courses comprising stable, increasing, and early-onset trajectories. These findings accord with recommendations from adult back pain guidelines that most children with spinal pain can be reassured that they do not have a serious disease and encouraged to stay active. What is Known: • Spinal pain imposes a large burden on individuals and society. • Although many people first experience the condition in childhood, little is known about the developmental trajectories of spinal pain from childhood to adolescence. What is New: • Data from 1556 children and 329,756 participant weeks showed five unique spinal pain trajectories from 6 to 17 years: most children rarely reported spinal pain, while one in five followed increasing or early-onset trajectories. • Most pain occurrences were non-specific; pathological diagnoses were rare.

Preliminary evidence points to a link between C-reactive protein (CRP) and spinal pain in adults. However, there is a paucity of research in younger populations. Therefore, we aimed to determine associations between CRP and spinal pain in childhood and adolescence. We identified trajectories of spinal pain from childhood to adolescence and investigated the associations between CRP and trajectory subgroups. Six- to 11-year-old children from 13 primary schools, were followed from October 2008 and until 2014. High-sensitivity CRP collected at baseline (2008) was measured using serum samples. The outcome was the number of weeks with non-traumatic spinal pain between November 2008 and June 2014. We constructed a trajectory model to identify different spinal pain trajectory subgroups. The associations between CRP and spinal pain trajectory subgroups were modelled using mixed-effects multinominal logistic regression. Data from 1556 participants (52% female), with a mean age of 8.4 years at baseline, identified five spinal pain trajectory subgroups: “no pain” (55.3%), “rare” (23.7%), “rare, increasing” (13.6%), “moderate, increasing” (6.1%), and “early onset, decreasing” (1.3%). There were no differences in baseline high-sensitivity CRP levels between spinal pain trajectory subgroups. Thus, the heterogeneous courses of spinal pain experienced were not defined by differences in CRP at baseline.

The COVID-19 pandemic and subsequent public health measures have resulted in a worsening of eating disorder symptoms and an increase in psychological distress. The present study examined symptoms and behaviors in adolescents and young adults with emotional eating, bingeing behaviors and binge eating disorder during the pandemic. Additionally, the study explored if individuals who experienced pandemic-related food availability and food affordability issues experienced increased binge-eating symptoms and negative feelings.Participants (n = 39) were a convenience sample who participated between November 2020 and January 2021 in a weight and lifestyle management program at an urban New England pediatric hospital. Participants completed online surveys that assessed (1) participant's exposure to COVID-19 related stress and binge-eating behaviors using the COVID-19 Exposure and Family Impact Survey-Adolescent and Young Adult Version (CEFIS-AYA) and the Binge Eating Scale (BES) respectively, (2) participants' and their families' ability to attain and afford food and its association with bingeing behaviors, and (3) the relationship between food availability and affordability and negative emotions.Nearly half of all participants (48.7%) reported moderate to severe bingeing during the COVID-19 pandemic; those who experienced greater COVID-related stress reported more binge-eating behaviors (p = 0.03). There were no associations between indicators of food availability and affordability and binge eating or between food availability and affordability and negative feelings.Higher pandemic-related stress was associated with more binge-eating behaviors among adolescents and young adults. These results underscore the need to monitor symptoms and provide treatment for these patients despite barriers to care imposed by the COVID-19 pandemic. Research and clinical care for adolescents and young adults with EDs must recognize and respond to pandemic effects across the weight and disordered eating spectrum.Research shows that the COVID-19 pandemic continues to have far-reaching adverse effects on mental health. For adolescents and young adults, the COVID-19 pandemic has altered critical aspects of their daily lives. The objective of this study is to investigate binge-eating behaviors in adolescents and young adults during the COVID-19 pandemic and to examine if individuals in households that experienced pandemic-related challenges such as food availability and food affordability had greater increases in bingeing behaviors and negative emotions such as feelings of anxiety, worry, mood, and loneliness. Thirty-nine adolescents and young adults previously assessed in an outpatient weight and lifestyle management program at an urban pediatric hospital were surveyed between November 2020 and January 2021. Almost half (48.7%) of these participants reported moderate to severe bingeing behaviors during the pandemic. Participants who reported higher impact of COVID-related stress on the CEFIS-AYA scale reported the highest level of binge-eating behaviors. There were no associations between food availability and affordability and binge eating or between food availability and affordability and negative feelings. This study highlights the importance of assessing patients’ perception of how they experience the myriad impacts of COVID-19 on their daily lives, and the critical need for increases in accessible mental health services and continued support during the on-going pandemic.

We sought to compare the ability of the prehospital Canadian C-Spine Rule to selectively recommend immobilization in sport-related versus non-sport-related injuries and describe sport-related mechanisms of injury.We reviewed data from the prospective paramedic Canadian C-Spine Rule validation and implementation studies in 7 Canadian cities. A trained reviewer further categorized sport-related mechanisms of injury collaboratively with a sport medicine physician using a pilot-tested standardized form. We compared the Canadian C-Spine Rule's recommendation to immobilize sport-related versus non-sport-related patients using Chi-square and relative risk statistics with 95% confidence intervals.There were 201 sport-related patients among the 5,978 included. Sport-related injured patients were younger (mean age 36.2 vs. 42.4) and more predominantly male (60.5% vs. 46.8%) than non-sport-related patients. Paramedics did not miss any C-Spine injury when using the Canadian C-Spine Rule. C-Spine injury rates were similar between sport (2/201; 1.0%) and non-sport-injured patients (47/5,777; 0.8%). The Canadian C-Spine Rule recommended immobilization equally between groups (46.4% vs. 42.5%; RR 1.09 95%CI 0.93-1.28), most commonly resulting from a dangerous mechanism among sport-injured (68.7% vs. 54.5%; RR 1.26 95%CI 1.08-1.47). The most common dangerous mechanism responsible for immobilization in sport was axial load.Although equal proportions of sport and non-sport-related injuries were immobilized, a dangerous mechanism was most often responsible for immobilization in sport-related cases. These findings do not address the potential impact of using the Canadian C-Spine Rule to evaluate collegiate or pro athletes assessed by sport medicine physicians. It does support using the Canadian C-Spine Rule as a tool in sport-injured patients assessed by paramedics.RéSUMé: OBJECTIFS: Nous avons cherché à comparer la capacité préhospitalière de la Canadian C-spine Rule à recommander de façon sélective l’immobilisation dans les blessures liées au sport par rapport aux blessures non liées au sport et à décrire les mécanismes des blessures liés au sport. LES MéTHODES: Nous avons examiné les données des études prospectives de validation et de mise en œuvre de la règle canadienne de la colonne vertébrale dans sept villes canadiennes. Un examinateur qualifié a ensuite classé les mécanismes de blessure liés au sport, en collaboration avec un médecin du sport, à l'aide d'un formulaire standardisé testé dans le cadre d'un projet pilote. Nous avons comparé la recommandation de la Canadian C-Spine Rule d'immobiliser les patients liés au sport par rapport aux patients non liés au sport en utilisant les statistiques du chi carré et du risque relatif avec un intervalle de confiance de 95 %. RéSULTATS: Parmi les 5 978 patients inclus il y avait 201 patients liés au sport. Les patients blessés liés au sport étaient plus jeunes (âge moyen 36,2 ans contre 42,4 ans) et plus majoritairement de sexe masculin (60,5 % contre 46,8 %) que les patients non liés au sport. Les ambulanciers paramédicaux n’ont manqué aucune blessure au rachis cervical lorsqu’ils ont utilisé la Canadian C-spine Rule. Les taux de blessures au rachis cervical étaient semblables chez les patients sportifs (2/201 ; 1,0 %) et non sportifs (47/5 777 ; 0,8 %). La Canadian C-spine Rule recommande l'immobilisation de manière égale entre les groupes (46,4 % contre 42,5 % ; RR 1,09 95 % IC 0,93-1,28), le plus souvent en raison d'un mécanisme dangereux chez les sportifs blessés (68,7 % contre 54,5 % ; RR 1,26 95 % IC 1,08-1,47). Le mécanisme dangereux le plus souvent responsable de l'immobilisation dans le sport était la charge axiale. CONCLUSION: Bien que des proportions égales de blessures sportives et non sportives aient été immobilisées, un mécanisme dangereux était le plus souvent responsable de l'immobilisation dans les cas liés au sport. Ces conclusions n'abordent pas l'impact potentiel de l'utilisation de la Canadian C-spine Rule pour évaluer les athlètes collégiaux ou professionnels évalués par les médecins du sport. Elle est favorable à l'utilisation de la Canadian C-spine Rule comme outil pour les patients blessés par le sport et évalués par les ambulanciers.

Impaired functional plasma membrane (PM) expression of the hERG K+-channel is associated with Long-QT syndrome type-2 (LQT2) and increased risk of cardiac arrhythmia. Reduced PM-expression is primarily attributed to retention and degradation of misfolded channels by endoplasmic reticulum (ER) protein quality control (QC) systems. However, as the molecular pathogenesis of LQT2 was defined using severely-misfolded hERG variants with limited PM-expression, the potential contribution of post-ER (peripheral) QC pathways to the disease phenotype remains poorly established. Here, we investigate the cellular processing of mildly-misfolded Per-Arnt-Sim (PAS)-domain mutant hERGs, which display incomplete ER-retention and PM-expression defects at physiological temperature. We show that the attenuated PM-expression of hERG is dictated by mutation-specific contributions from both the ER and peripheral QC systems. At the ER, PAS-mutants experience inefficient conformational maturation coupled with rapid ubiquitin-dependent proteasomal degradation. In post-ER compartments, they are rapidly endocytosed from the PM via a ubiquitin-independent mechanism and rapidly targeted for lysosomal degradation. Conformational destabilization underlies aberrant cellular processing at both ER- and post-ER compartments, since conformational correction by a hERG-specific pharmacochaperone or low-temperatures can restore WT-like trafficking. Our results demonstrate that the post-ER QC alone or jointly with the ER QC determines the loss-of-PM-expression phenotype of a subset of LQT2 mutations.

Ecological Momentary Assessment (EMA) data consists of in-the-moment sampling several times per day aimed at capturing phenomena that are highly variable. When research questions are focused on the association between a construct measured repeatedly and an event that occurs sporadically over time interspersed between repeated measures, the data consist of correlated observed or censored times to an event. In such a case, specialized time-to-event models that account for correlated observations are required to properly assess the relationships under study. In the current study, we apply two time-to-event analysis techniques, proportional hazards and accelerated failure time modeling, to data from a study of affective states and sexual behavior in depressed adolescents and illustrate differing interpretations from the models.

We investigated individual- and couple-level associations between daily intimacy and affective states (N = 2211 observations) in 20 heterosexual emerging adult couples (age 18–25 years, M = 23) who had been in a sexual relationship with one another for at least 3 weeks (M = 12 months). Individual analyses revealed that emerging adults’ feelings of intimacy varied from day to day and that there were no gender differences in daily intimacy. Affect and intimacy were positively associated within day for women, but not for men. Time-lagged individual-level analyses revealed that prior-day positive or negative affect did not predict present-day intimacy for men or women. However, prior-day intimacy positively predicted present-day positive affect in men and negatively predicted present-day negative affect in women. Time-lagged couple-level analyses revealed that men’s prior-day positive affect positively predicted their female partner’s present-day intimacy. Women’s prior-day intimacy negatively predicted their male partner’s present-day negative affect. Implications of the day-to-day associations of intimacy with positive and negative affect within emerging adult couples are discussed.

Introduction: The Canadian C-Spine rule (CCR) was validated for use by paramedics to selectively immobilize stable trauma patients. However, the CCR “Dangerous Mechanism” is highly prevalent in sports. Our objective was to compare the CCR performance in sport-related vs. non-sport-related injuries and describe sport-related mechanisms of injury. Methods: We reviewed data from the prospective paramedic CCR validation and implementation studies in 7 Canadian cities, which already included identification of sport-related injuries. A single trained reviewer further categorized mechanisms of injury using a pilot-tested standardized form, with the aid of a sport medicine physician in 15 ambiguous cases. We compared the CCR's recommendation to immobilize sport-injured versus non-sport-injured patients using chi-square and relative risk statistics with 95% confidence intervals. Results: There were 201 amateur sport-injuries among the 5,978 patients. Sport-injured patients were younger (mean age 36.2 vs. 42.4) and more predominantly male (60.5% vs 46.8%) than non-sport-injured patients. Paramedics did not miss any c-spine injuries when using the CCR. Although cervical spine injury rates were similar between sport (2/201; 1.0%) and non-sport injured patients (47/5,777; 0.8%), the absolute number of sport-related injuries was very small. Although CCR recommended immobilization equally between the two groups (46.4% vs 42.5% p = 0.29; RR 1.17 95%CI 0.87-1.57), the reason for immobilization was more likely to be a dangerous mechanism in sport injuries (68.6% vs 54.5%, p = 0.012). Although we observed a wide range of mechanisms, the most common dangerous mechanism responsible for immobilization in sport was axial load. Conclusion: The CCR identified all significant c-spine injuries in a cohort of patients assessed and transported by paramedics. Although an equal proportion of sport and non-sports related injuries were immobilized, a dangerous mechanism was most often responsible for immobilization in sport-related cases. These findings do not address the potential impact of using the CCR to evaluate all sport-related injuries in collegiate or pro athletes evaluated by sport medicine therapists and physicians, as these patients are rarely assessed by paramedics or transported to a hospital. It does support the safety and benefit of using the CCR in sport-injured patients for which paramedics are called.

Cardiac and neural systems share common features of intrinsic oscillation in some cells as well as the ability to propagate excitation. One theoretical approach to study such systems is to develop realistic models for the tissue. This involves first developing detailed ionic "Hodgkin-Huxley"-type models of individual cells and then connecting the individual cells via synaptic and gap junctions in realistic geometries. An alternative approach is to characterize tissue in terms of functional properties such as phase resetting curves and restitution curves. Using simple models based on one-dimensional difference equations, the measured functional curves can be used to predict, analyze, and interpret nonlinear dynamical phenomena. This approach offers the prospects of providing simplified descriptions that offer insight into the experimental and clinical cardiac dynamics.

The present study involved an in vitro examination of spinal cord interstitial pressure (CIP) during distraction before and after durotomy in three spinal cord segments obtained from five pigs.To determine whether durotomy can be used to decrease the elevated CIP associated with spinal cord distraction.Spinal cord distraction is a known cause of spinal cord injury. Several articles describing the pathophysiology of cord distraction injuries suggest that the underlying mechanism of injury is a microvascular ischemic event. The authors have previously described an increase in CIP with spinal cord distraction, with average pressures of 23 mmHg at loads of 1,000 g. To date, there are no published studies that have evaluated the efficacy of intentional durotomies as a treatment for elevated CIP.A total of 15 spinal cord sections were harvested from pigs and distracted while immersed in saline, using a fixed 1,000 g distraction force. The CIP decay was then measured at 30-s intervals for 10 min. The distraction/relaxation maneuver was performed six times with continuous CIP monitoring and was subsequently followed by durotomy.The pressure-decay curves were similar for each specimen, but varied according to individual pigs and anatomical levels. CIP decayed over the first 4 min of distraction and remained constant for the final 6 min. Longitudinal durotomy led to a dramatic drop in CIP toward baseline and appeared to be as effective as transverse durotomy with regard to the normalization of pressure.Spinal cord distraction causes elevations in CIP. Durotomy lowers elevated CIP in vitro and may be effective at lowering CIP in vivo. Further study is required to evaluate the usefulness of durotomy in vivo.

Background: Repetitive tasks in the workplace are one cause of injury. This study aimed to identify injuries specific to physicians routinely performing colonoscopy, and to identify prevention strategies. Methods: A survey was sent to all 2,173 worldwide members of the American Society for Colon and Rectal Surgery to investigate injuries or disabilities that resulted from performing colonoscopy and the methods used to prevent and alleviate symptoms related to the procedure. Results: The response rate was 28%. Of the respondents, 96% performed colonoscopy. At least one injury or pain believed to result from performing colonoscopy was reported by 39% of the respondents. The most frequently reported injuries were to hands and fingers (n = 257), neck (n = 65), and back (n = 52). The methods adopted to alleviate injury included changing the height of the stretcher or video monitor, changing from a standing to a sitting position, minimizing torque on the colonoscope, having an assistant perform the torque maneuver, and resting or taking time off from colonoscopy. Two respondents also created devices to make the instrument more ergonomic. Conclusion: The number of colorectal surgeons encountering injury from colonoscopy highlights the need for preventive strategies. The study results suggest that it may be necessary to improve the design of colonoscopes to make them more ergonomic. Appropriate positioning of the endoscopist, patient, and monitors may diminish some of the injuries encountered.

There are only a few anecdotal reports of cytomegalovirus (CMV) colitis in immunocompetent hosts. The impact of the disease in this patient population remains poorly understood. The aim of this study was to perform a meta-analysis using individual patient data to determine outcomes of CMV colitis in immunocompetent patients and identify risk factors that might influence prognosis. A literature search was performed from 1980 to 2003 looking for immunocompetent patients with CMV colitis. Immunocompetence was defined as absence of congenital or acquired immune deficiency, transplant, or immunosuppressive medication. Patients were divided by age (< 55 versus ≥55) and grouped according to coexisting illnesses. Kaplan–Meier curves were plotted to assess survival. Variables included age, sex, site of acquisition of infection, extent of disease, coexisting illnesses, and treatment modality. A total of 44 patients were identified, with an average age of 61.1. Only 10 were free of any comorbidity. The mean follow-up was 13.4 months. Spontaneous remission occurred in 31.8%, mostly individuals < 55 years old. Fourteen deaths occurred, all of which were in patients ≥55. There was a higher mortality rate among male patients ≥55 (56.9%; P = 0.08), patients with immune-modulating diseases (75.2%; P = 0.10), and those having a colectomy (68.9%; P = 0.09). This analysis underlines the rarity of CMV colitis in patients with an intact immune system. Advanced age, male gender, presence of immune-modulating comorbidities, and need for surgical intervention are factors negatively influencing survival. Conversely, young healthy patients have a good prognosis with no intervention.

Objectives:Acute compartment syndrome (ACS) is a limb-threatening condition often first diagnosed by emergency physicians. Little is known about the rapidity with which permanent damage may occur. Our objective was to estimate the time to muscle necrosis in patients with ACS.Methods:This historical cohort analysis of all patients who had a fasciotomy for ACS was conducted in 4 large teaching hospitals. Diagnosis was confirmed clinically or by needle measurement of compartment pressure. Muscle necrosis was determined using pathology reports and surgeons’ operative protocols. We used descriptive statistics and estimated tissue survival probability using the Vertex exchange method for interval-censored data.Results:Between 1989 and 1997 there were 76 cases of ACS. Most cases occurred in young men (median age 32) as a result of a traumatic incident (82%). Forty-nine percent (37/76) of all patients suffered some level of muscle necrosis, and 30% (11/37) of those with necrosis lost more than 25% of the muscle belly. Necrosis occurred in 2 of 4 cases in which the patient had been operated on within 3 hours of the injury, and our exploratory survival analysis estimates that 37% (95% confidence interval, 13%-51%) of all cases of ACS may develop muscle necrosis within 3 hours of the injury.Conclusions:This is the largest cohort of ACS and the first clinical estimation of time to muscle necrosis ever published. Ischemia from ACS can cause muscle necrosis before the 3-hour period post-trauma that is traditionally considered safe. Further research to identify risk factors associated with the development of early necrosis is necessary.

BACKGROUND: Distal adenomas have been considered markers of proximal neoplasms. It also has been suggested that patients with small, distal adenomas do not require proximal examination of the colon. This study was conducted to determine the validity of the latter recommendation. METHODS: From a total of 5,132 colonoscopies performed between 1976 and 1999, all patients from whom adenomas were removed were included. Those with previous colon resections or incomplete cecal intubation were excluded. Proximal adenomas were defined as those proximal to the sigmoid colon. Adenomas were considered advanced if they were 1 cm or larger, contained any villous component, or demonstrated severe dysplasia. RESULTS: The study included 226 patients. Overall, 98 patients had distal adenomas, and there was a synchronous proximal adenomas rate of 23.4%. Patients with single, small, rectosigmoid, tubular adenomas had proximal adenomas at a rate of 28.8%, and 9.6% were advanced adenomas. Patients with advanced distal adenomas had synchronous proximal adenomas at a rate of 18.9%, and 10.8% of these were advanced adenomas. According to multiple logistic regression, the strongest predictor of proximal neoplasia was the absence of distal polyps. CONCLUSION: These data confirm the necessity for total colonoscopy in all patients with distal adenomas regardless of size. In addition, the high proportion of proximal neoplasia without distal markers suggests that full colonoscopy may be warranted as a screening tool in all patients.

Raising the intracellular pH (pHi) above 7.7 in intracellularly perfused squid giant axons causes spontaneous firing of action potentials. The firing frequency ranged from 20 Hz at 0°C to 200 Hz at 23°C. Above 23°C, the axons were quiescent. They were bistable for 13

Lactulose has been proposed to be beneficial in treating inflammatory bowel disease (IBD). The hypothesis is based on the prebiotic potential of lactulose. A practical approach to testing its usefulness is to determine colonic adaptation to tolerable doses in patients with IBD. Our objective was to determine if a 3-week course of lactulose will decrease BH2 and symptoms in response to an acute lactulose challenge test in control subjects and IBD patients. The design was a Prospective cohort study. Subjects were given a 30-g lactulose challenge test (test 1), and then ingested 10 g of lactulose twice a day for 3 weeks before being retested (Test 2). A third test was given after a further 5-week washout period. The main outcomes were the change in 4-hr sum of BH2 (Σ4HrBH2) values obtained every 30 min, peak BH2, and 4-hr sum of symptom score (Σ4HrSS) during the lactulose challenge test. In addition, we also report the change in self-reported symptoms and diarrhea during the 3-week administration of lactulose. In controls, Σ4HrBH2 decreased from test 1 (380.5 ± 56.6 ppm) to test 2 (288.6 ± 57.4 ppm) (P 0.5). Unlike controls, the Σ4HrBH2 in patients failed to achieve significance between test 1 (444.5 ± 55.8 ppm), test 2 (366.5 ± 80.7 ppm, P > 0.2) or test 3 (411.6 ± 62.5 ppm, P > 0.2). Σ4HrSS results in controls followed a pattern similar to Σ4HrBH2, achieving significance only in test 2 (P 0.5). Symptoms were lower in patients and varied insignificantly both in challenges and intertest periods. In conclusion, although controls adapt to a 3-week period of lactulose ingestion, IBD patients fail to meet the criteria for adaptation. However, longer studies may be needed to establish whether IBD patients are slower to adapt.

Background Major depressive disorder (MDD) may be present in 10%–20% of patients in medical settings. Routine depression screening is sometimes recommended to improve depression management. However, studies of the diagnostic accuracy of depression screening tools have typically used data-driven, exploratory methods to select optimal cutoffs. Often, these studies report results from a small range of cutoff points around whatever cutoff score is most accurate in that given study. When published data are combined in meta-analyses, estimates of accuracy for different cutoff points may be based on data from different studies, rather than data from all studies for each possible cutoff point. As a result, traditional meta-analyses may generate exaggerated estimates of accuracy. Individual patient data (IPD) meta-analyses can address this problem by synthesizing data from all studies for each cutoff score to obtain diagnostic accuracy estimates. The nine-item Patient Health Questionnaire-9 (PHQ-9) and the shorter PHQ-2 and PHQ-8 are commonly recommended for depression screening. Thus, the primary objectives of our IPD meta-analyses are to determine the diagnostic accuracy of the PHQ-9, PHQ-8, and PHQ-2 to detect MDD among adults across all potentially relevant cutoff scores. Secondary analyses involve assessing accuracy accounting for patient factors that may influence accuracy (age, sex, medical comorbidity). Methods/design Data sources will include MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science. We will include studies that included a Diagnostic and Statistical Manual or International Classification of Diseases diagnosis of MDD based on a validated structured or semi-structured clinical interview administered within 2 weeks of the administration of the PHQ. Two reviewers will independently screen titles and abstracts, perform full article review, and extract study data. Disagreements will be resolved by consensus. Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Bivariate random-effects meta-analysis will be conducted for the full range of plausible cutoff values. Discussion The proposed IPD meta-analyses will allow us to obtain estimates of the diagnostic accuracy of the PHQ-9, PHQ-8, and PHQ-2. Systematic review registration PROSPERO CRD42014010673

Background: Cardiovascular disease and type 2 diabetes are examples of chronic diseases that impose significant morbidity and mortality in the general population worldwide. Most chronic diseases are associated with underlying preventable risk factors, such as elevated blood pressure, high blood glucose or glucose intolerance, high lipid levels, physical inactivity, excessive sedentary behaviours, and overweight/obesity. The occurrence of intermediate outcomes during childhood increases the risk of disease in adulthood. Sugar-sweetened beverages are known to be significant sources of additional caloric intake, and given recent attention to their contribution in the development of chronic diseases, a systematic review is warranted. We will assess whether the consumption of sugar-sweetened beverages in children is associated with adverse health outcomes and what the potential moderating factors are. Methods/Design: Of interest are studies addressing sugar-sweetened beverage consumption, taking a broad perspective. Both direct consumption studies as well as those evaluating interventions that influence consumption (e.g. school policy, educational) will be relevant. Non-specific or multi-faceted behavioural, educational, or policy interventions may also be included subject to the level of evidence that exists for the other interventions/exposures. Comparisons of interest and endpoints of interest are pre-specified. We will include randomized controlled trials, controlled clinical trials, interrupted time series studies, controlled before-after studies, prospective and retrospective comparative cohort studies, case–control studies, and nested case–control designs. The MEDLINE®, Embase, The Cochrane Library, CINAHL, ERIC, and PsycINFO® databases and grey literature sources will be searched. The processes for selecting studies, abstracting data, and resolving conflicts are described. We will assess risk of bias using design-specific tools. To determine sets of confounding variables that should be adjusted for, we have developed causal directed acyclic graphs and will use those to inform our risk of bias assessments. Meta-analysis will be conducted where appropriate; parameters for exploring statistical heterogeneity and effect modifiers are pre-specified. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be used to determine the quality of evidence for outcomes.

Background: Research on psychological risk factors for injury has focused on stable traits. Our objective was to test the feasibility of a prospective longitudinal study designed to examine labile psychological states as risk factors of injury. Methods: We measured psychological traits at baseline (mood, ways of coping and anxiety), and psychological states every day (1-item questions on anxiety, sleep, fatigue, soreness, self-confidence) before performances in Cirque du Soleil artists of the show “O”. Additional questions were added once per week to better assess anxiety (20-item) and mood. Questionnaires were provided in English, French, Russian and Japanese. Injury and exposure data were extracted from electronic records that are kept as part of routine business practices. Results: The 43.9% (36/82) recruitment rate was more than expected. Most artists completed the baseline questionnaires in 15 min, a weekly questionnaire in