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Cognitive control is a predictor of later‐life outcomes and may underpin higher order executive processes. The present study examines the development of early cognitive control during the first 24‐month. We evaluated a tablet‐based assessment of cognitive control among infants aged 18‐ and 24‐month. We also examined concurrent and longitudinal associations between attentional disengagement, general cognitive skills and cognitive control. Participants (N = 60, 30 female) completed the tablet‐task at 18‐ and 24‐month of age. Attentional disengagement and general cognitive development were assessed at 5‐, 8‐, 12‐, 18‐ and 24‐month using an eye‐tracking measure and the Mullen Scales of Early Learning (MSEL), respectively. The cognitive control task demonstrated good internal consistency, sensitivity to age‐related change in performance and stable individual differences. No associations were found between infant cognitive control and MSEL scores longitudinally or concurrently. The eye‐tracking task revealed that slower attentional disengagement at 8‐month, but faster disengagement at 18‐month, predicted higher cognitive control scores at 24‐month. This task may represent a useful tool for measuring emergent cognitive control. The multifaceted relationship between attention and infant cognitive control suggests that the rapid development of the attentional system in infancy results in distinct attentional skills, at different ages, being relevant for cognitive control development. [ABSTRACT FROM AUTHOR]

Background Much of the evidence underlying guidelines for producing accessible information for people with aphasia focuses on client preference for particular design features. There is limited evidence regarding the effects of these features on comprehension. Aims To examine the effects of specific design features on text comprehension. It was hypothesized that font style, letter case and supporting images would all have a significant impact on people with aphasias' ability to comprehend text. Methods & Procedures Participants ( N = 9) read 35 paragraphs and selected the most appropriate word or phrase from a choice of four to finish the final sentence. Reading comprehension was assessed in three conditions: font style, letter case and text with a supporting image. One-way analyses of variance (ANOVAs) with Bonferroni post-hoc tests were used to test the effect of each design feature on reading comprehension. Outcomes & Results People with aphasia comprehended significantly more written information when presented in sans-serif font than in a serif style ( p = .01) and when presented in lower case than in upper case ( p = .03). The inclusion of a single supporting image to illustrate a paragraph of text did not have a significant effect on comprehension. Conclusions & Implications This research supports the premise that font style and letter case have a significant effect on text comprehension, but that illustrating a paragraph of text with a single image may not significantly improve comprehension when text is written at a low readability level. Although it is critical to produce accessible information, improving comprehension is only one rationale for modified text presentation and therefore these results must be viewed in the context of other recommendations. [ABSTRACT FROM AUTHOR]

Background The glycaemic responses of staples differ when eaten as mixed meals. We determined the glycaemic responses and glycaemic index (GI) values for common South Asian carbohydrate rich foods and the effect of adding curried chicken to them as mixed meals. Methods The GI and glycaemic response to staples (basmati rice, pilau rice and chapatti) and mixed meals (pilau rice with chicken curry and chapatti with chicken curry) were measured in healthy volunteers. Paired comparisons in each subject were carried out for staples and their equivalent mixed meals ( n = 9). Results GI values for the mixed meals were significantly lower than the staples alone (41 and 60 for pilau rice with chicken curry and pilau rice alone, P = 0.001; 45 and 68 for chapatti with chicken curry and chapatti alone, P = 0.004). Both, pilau rice and chapatti with chicken curry had a significantly lower glycaemic response than their equivalent staples alone: incremental area under the blood glucose response curves (IAUC) 111.9 mmol min−1 L−1 for pilau rice with curry versus 162.4 mmol min−1 L−1 for pilau rice alone ( P = 0.001) and IAUC 110.1 mmol min−1 L−1 for chapatti with chicken curry versus 183.6 mmol min−1 L−1 for chapatti alone ( P = 0.002). Conclusions Adding fat and protein-containing curries as part of a mixed meal to carbohydrate rich staple foods reduced glycaemic responses, and also changed the GI category. [ABSTRACT FROM AUTHOR]

Background Bioelectrical impedance analysis would be a more practical tool to measure body composition in clinical settings, dietetic practice and epidemiological studies if patients/subjects did not have to fast before measurements. The present study assessed whether the ingestion of food or drink had any biologically significant effect on bioimpedance measurements and body composition by the foot-to-foot method. Methods Fifty-five healthy adults [30 males and 25 females; mean (SD) age 27.7 (7.1) years; mean (SD) body mass index 24 (3.8) kg m−2] were randomly assigned to a 2-day food trial (high-fat meal or high-carbohydrate meal) or a 2-day drink trial (water or high electrolyte drink). Body composition measurements were carried out in the fasting state, immediately after meal consumption and every 30 min for 2 h by the foot-to-foot single frequency bioimpedance technique. Results Bioimpedance increased significantly after the ingestion of food and fluid, although the changes were small. The electrolyte drink, high-fat and high-carbohydrate meals significantly increased the percentage body fat and fat mass. In all cases, the median percentage changes from baseline were approximately 1% in body fat percentage units. Conclusions Although there were statistically significant changes in body composition estimates after food or drink consumption, these were small and within the imprecision of the impedance technique, and so are unlikely to be of clinical significance. The present study suggests that impedance measures of body fatness in clinical settings do not require strict adherence to fasting, and this should increase the opportunities for clinical application. [ABSTRACT FROM AUTHOR]

Background Fruit and vegetable-rich diets are associated with a reduced cardiovascular disease ( CVD) risk. This protective effect may be a result of the phytochemicals present within fruits and vegetables ( F&V). However, there can be considerable variation in the content of phytochemical composition of whole F&V depending on growing location, cultivar, season and agricultural practices, etc. Therefore, the present study investigated the effects of consuming fruits and vegetables as puree-based drinks ( FVPD) daily on vasodilation, phytochemical bioavailability, antioxidant status and other CVD risk factors. FVPD was chosen to provide a standardised source of F&V material that could be delivered from the same batch to all subjects during each treatment arm of the study. Methods Thirty-nine subjects completed the randomised, controlled, cross-over dietary intervention. Subjects were randomised to consume 200 m L of FVPD (or fruit-flavoured control), daily for 6 weeks with an 8-week washout period between treatments. Dietary intake was measured using two 5-day diet records during each cross-over arm of the study. Blood and urine samples were collected before and after each intervention and vasodilation assessed in 19 subjects using laser Doppler imaging with iontophoresis. Results FVPD significantly increased dietary vitamin C and carotenoids ( P < 0.001), and concomitantly increased plasma α- and β-carotene ( P < 0.001) with a near-significant increase in endothelium-dependent vasodilation ( P = 0.060). Conclusions Overall, the findings obtained in the present study showed that FVPD were a useful vehicle to increase fruit and vegetable intake, significantly increasing dietary and plasma phytochemical concentrations with a trend towards increased endothelium-dependent vasodilation. [ABSTRACT FROM AUTHOR]

Background and Purpose Healthy individuals have a top-down coordination pattern when turning while walking; they first rotate the head, then the shoulders, the pelvis and, finally, the feet. The aim of this study was to compare spatial and temporal characteristics of head and trunk rotation in sitting between people early after stroke and healthy participants, and investigate change over time. Methods This was a pilot, quantitative, longitudinal study. We recruited participants from stroke wards and local groups. People with stroke were assessed at 3, 6 and 12 weeks after stroke. Healthy participants were examined with the same weekly intervals. Participants were in a seated position and were asked verbally to rotate their head and look at a visual signal placed at 90° to the left and to the right of the subject. CODAmotion (Charnwood Dynamics Ltd, Rothley, UK) was used for 3-D motion recording and analysis. Results Healthy participants (two women and four men; mean age 66 years) showed significant rotation of the head before rotation of the shoulders at all three time points; people with stroke (one woman and five men; mean age 71 years) did not show this top-down pattern of movement. There was no significant difference between start times of head and shoulder rotation at 3 ( p = 0.167), 6 ( p = 0.084) and 12 weeks after stroke ( p = 0.062). Conclusions. The results of our pilot study warrant further investigation into the recovery and pattern of axial coordination after stroke. Future studies could provide insight into the mechanisms behind impaired postural control in people after stroke. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Unhealthy eating patterns in childhood can lead to adverse health conditions, particularly obesity. However, debate remains around the precise eating behaviours that lead to these conditions. The present study aimed to address this lack of evidence by reporting on the eating frequency, breakfast consumption and body mass index (BMI, kg m-2) of youth in the UK. Methods: A total of 264 (133 boys and 131 girls) participants, aged 10-13 years, completed self-report measures of dietary intake via 3-day food/drink diaries (Friday to Sunday). Trained researchers recorded height and weight to calculate the BMI. Diaries were analysed using dietplan 6 nutritional analysis software (Forestfield Software, Horsham, UK) and multivariate linear regression was used to examine any association between breakfast consumption, frequency of eating and BMI. Results: No relationship existed between BMI Z-score, eating frequency and breakfast consumption. However, frequent breakfast consumers had significantly lower mean (SD) BMI Z-scores [0.18 (1.06) versus 0.57 (1.23)] and higher intakes of iron, calcium and vitamin E than those who did not eat breakfast regularly. Those aged ≥11 years consumed breakfast less frequently [0.92 (0.20)] and were less likely to eat regularly [4.6 (1.4)] than those aged ≤10 years. Conclusions: Older boys were the least likely to eat regularly and the least likely to consume breakfast. Promoting the importance of regular eating, particularly breakfast consumption to these boys, may be essential to ensure healthier, long-term eating patterns. Furthermore, the lower breakfast intakes in 11-13-year-olds and higher BMI Z-scores of those who did not eat breakfast regularly should be monitored. [ABSTRACT FROM AUTHOR]

The Low Income Diet and Nutrition Survey described the food consumption and nutrient intake of UK children in low income households in 2003-2005. To describe food consumption and nutrient intake associated with school meals and packed lunches, based on a cross-sectional analysis of 680, 24-h dietary recalls from 311 school children aged 4-11 years. In children from low income households, pupils who took a packed lunch consumed more white bread, fats and oils, crisps and confectionery and fewer potatoes (cooked with or without fat) at lunchtime compared to other pupils. Many of these differences persisted when diet was assessed over the day. For younger pupils (4-7 years), packed lunches provided the least amount of folate, the highest amount of sodium, and the highest average percentage of food energy from fat and saturated fatty acids (SFA) compared to free school meals (FSMs). Over the whole day, in both younger (4-7 years) and older (8-11 years) children, there were no notable differences in energy or nutrient intake between those eating a packed lunch or a school meal. Older children's packed lunches contributed a significantly higher proportion of fat, SFA, calcium and sodium to the day's nutrient intake compared to a FSM. In children from low income households, packed lunches are less likely to contribute towards a 'healthier' diet compared to a school meal. The difference was more apparent in younger children. Key differences were the high consumption of sodium, SFA and non-milk extrinsic sugars by pupils who had packed lunches. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the thermal and non-thermal effects of pulsed short wave therapy (PSWT) using high and low dose of PSWT together with placebo and control conditions in healthy subjects. A single-blind, crossover design was employed with 31 subjects who all participated in three conditions: High PSWT (PD 200 μsec, PRR 800 Hz, MP 24 W, 10 minutes), Low PSWT (PD 100 μsec, PRR 200 Hz, MP 3 W, 10 minutes), and Placebo PSWT (PD 20 μsec, PRR 50 Hz, MP 0.05 W, 10 minutes). Fourteen subjects additionally participated in a Control condition (no treatment, 10 minutes). Measurements of skin temperature, blood flow, heart rate, and core temperature were taken before, during, and after the application of PSWT. Data were analyzed using a repeated measures analysis of variance (ANOVA) model with a Bonferroni post-hoc comparison. A significant increase in blood volume and skin temperature with both the high- and low-dose applications during the treatment period was demonstrated. There were significant differences between time periods and between treated and untreated limbs compared with the control condition. The blood flow changes during the low-dose application were not significantly different from placebo. Some subjects were unable to detect significant changes in skin temperature. Significant physiological changes associated with the application of PSWT have been demonstrated, challenging the notion of a lack of effect of this therapy. The study also demonstrated a measurable increase in skin temperature, which was not associated with thermal sensory perception; thus, skin sensation may not be clinically reliable for detecting real changes in temperature. Subjects with a wide age range of ages were deliberately recruited; however, these results may not extrapolate to a patient population who could react differently to the same intervention. Further studies in the clinical environment are therefore needed. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This investigation determined the efficacy of a tart cherry juice in aiding recovery and reducing muscle damage, inflammation and oxidative stress. Twenty recreational Marathon runners assigned to either consumed cherry juice or placebo for 5 days before, the day of and for 48 h following a Marathon run. Markers of muscle damage (creatine kinase, lactate dehydrogenase, muscle soreness and isometric strength), inflammation [interleukin-6 (IL-6), C-reactive protein (CRP) and uric acid], total antioxidant status (TAS) and oxidative stress [thiobarbituric acid reactive species (TBARS) and protein carbonyls] were examined before and following the race. Isometric strength recovered significantly faster ( P=0.024) in the cherry juice group. No other damage indices were significantly different. Inflammation was reduced in the cherry juice group (IL-6, P<0.001; CRP, P<0.01; uric acid, P<0.05). TAS was ∼10% greater in the cherry juice than the placebo group for all post-supplementation measures ( P<0.05). Protein carbonyls was not different; however, TBARS was lower in the cherry juice than the placebo at 48 h ( P<0.05). The cherry juice appears to provide a viable means to aid recovery following strenuous exercise by increasing total antioxidative capacity, reducing inflammation, lipid peroxidation and so aiding in the recovery of muscle function. [ABSTRACT FROM AUTHOR]

An abstract of the article "Improving the quality of packed lunches in primary school children," by N. Cooper and C. Jones is presented.

An abstract of the article "The availability and cost of a milk-free diet for cow's milk protein allergy," by S. P. Shah and R. Towell is presented.

An abstract of the article "A text message-based weight management intervention for overweight adults," by E. L. Donaldson and S. Fallows is presented.

The article presents a study which compares the costs of a basket of food that matches with healthy eating guidelines and a standard basket of food in different socioeconomic status (SES) in Great Britain. It examines the difference between the cost of healthy food basket and standard food basket. It notes the findings of the study that show that the cost of the healthy food basket was more expensive than the standard food basket and the difference between the cost of such baskets was small.

Individuals at increased cardio-metabolic (CM) risk have a greater chance of developing diabetes mellitus and suffering premature cardiovascular events. The metabolic syndrome (MetS) is a constellation of risk factors which confer increased CM risk. MetS was originally proposed by Reaven (1998) and the currently accepted definition was agreed by AHA/NHLBI,WH,IASIASO (Alberti et al., 2009). More recently, increased liver fat has been proposed as a marker of CM risk. The aims of this study were to evaluate the inter-relationships between percentage liver fat and established CM risk factors and identify those with MetS. This paper presents a secondary analysis of baseline data from a sample ( n = 37) (56 ± 5.32 years), of overweight men who were at increased CM risk but otherwise healthy,, and recruited into a randomised dietary intervention crossover study to investigate how dietary carbohydrate influences the metabolism of plasma lipoproteins in overweight volunteers with moderately high (>10% <20%) and low (<2%) levels of liver fat. Anthropometric and biochemistry measurements were obtained, and from a sub-sample, the percentage of liver fat by magnetic resonance imaging. The participants were also assigned a metabolic score based on the number of indicators of the MetS according to the AHA/NHLBI, WH, IASIASO definition (Alberti, 2009). Non-parametric statistical analyses was used, as not all variables were normally distributed, there were a number of outliers and a small sample size. Pearson Correlation Co-efficients were used to investigate relationships between continuous and categorical variables. The variables were not adjusted for age or BMI because of a small sample size. Statistical significance was set at P ≤ 0.05 and all analyses were carried out using SPSS 16.0. Fifty nine per cent of the participants had MetS ( n = 21). There was evidence of significant, positive associations between the metabolic score for MetS and total cholesterol:HDL-C ratio ( P = 0.030), and between percentage liver fat and plasma glucose and insulin ( P = 0.010 and P = 0.003 respectively). The percentage of liver fat was also notably higher than that reported in other studies (Yamada et al., 2010; Kotronen et al., 2007) and there was positive correlation between the liver enzyme alanine transaminase (ALT) and plasma insulin ( P = 0.012). The strong associations between established risk factors and liver fat suggest that the latter may be clinically useful as a marker for CM risk in MetS. Alberti, K., Eckel, R., Grundy, S. et al. (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation, 1640-1645. Kotronen, A., Westerbacka, A., Bergholm, R., Pietilainen, K.H. & Yki-Jarvinen, H. (2007) Liver fat in the metabolic syndrome. J. Clin. Endocrinol. Metab. , 3490-3497. Reaven, G. (1998) Insulin resistance and human disease: a short history. J. Basic Clin. Physiol. Pharmacol., 387-406. Yamada, T., Fukatsu, M., Suzuki, S. et al. (2010) Fatty liver predicts impaired fasting glucose and type 2 diabetes mellitus in Japanese undergoing a health checkup. J. Gastroenterol. Hepatol., 352-356. [ABSTRACT FROM AUTHOR]

The Foresight report (Butland et al., 2007) has identified that risk perception is an area where additional evidence is needed to improve the understanding of obesity. The Department of Health (2009) reports university students as a group vulnerable to weight gain and therefore future programs for obesity could be informed by the knowledge of the target group. The aim of this project was to investigate the knowledge of Coventry University students regarding the health risks associated with obesity. Non-probability convenience sampling was used to recruit 40 participants from Coventry University. Data was collected using a 'pen-and-paper' questionnaire format and the validated Obesity Risk Knowledge-10 scale (ORK-10 scale) was used to assess level of knowledge (Swift 2006). The ORK-10 Scale consists of 10 brief questions covering obesity related co-morbidities such as diabetes, cancer, life expectancy and high blood pressure, with the option of answering true, false or don't know. Each correct answer scored 1 point, therefore a higher score indicated greater knowledge. Socio-demographic data including gender, age, ethnicity, course and faculty were also collected. Because of the small sample size of the study, these independent variables were dichotomised; gender into male and female, age groups into <20 and >20 years, ethnicity into Caucasian and non-Caucasian, course into undergraduate and postgraduate and faculty into health and life sciences compared with other faculties. A Kolmogorov-Smirnov test was used to assess the normality of the distribution of ORK-10 scale scores. The results indicated normal distribution of ORK-10 score for gender, ethnicity, course and faculty groups, supporting the use of a t-test. For comparing scores between age groups, the data was not normally distributed, supporting the use of a nonparametric Mann-Whitney U-test. The study received approval from the Coventry University Ethics Committee. The participant population consisted of 16 males and 24 females, 13 < 20 and 27 > 20 years of age, 25 Caucasians and 15 non-Caucasians, 36 undergraduates and four postgraduates, and 20 in the health and life sciences faculty and 20 in other faculties including engineering and computing, art and design, business, environment and society, and lifelong learning. No significant differences were found in ORK-10 scores between gender ( P = 0.276), ethnicity ( P = 0.179), course ( P = 0.310), or faculty ( P = 0.168). However, a statistically significant difference was found in ORK-10 scores between age groups, participants >20 years of age had a greater level of knowledge (median = 6, interquartile range = 4), compared to those <20 years of age (median = 4, interquartile range = 2), P = 0.031. Significant differences were observed in ORK-10 scores according to age with older students scoring higher. This agrees with the finding of Swift (2006) and may be explained by the increased exposure of this age group to health messages. In contrast to previous findings (Swift 2006), studying health and life sciences was not associated with increased knowledge of health risks. This may be explained by the limited sample size of the study, the students may have been in the early stages of their course, sampling bias may have meant that only students interested in health took part, and the sampling technique may not have been representative of the population. This study found a statistically significant relationship between knowledge of health risk associated with obesity and age of the students. There is a need for further research in this area, and future studies of larger randomly selected students would help to confirm the need for targeted obesity education programs. The results conclude that students <20 years of age should be considered as a target population for future obesity education programs, in order to make a positive impact on heath behaviour and dietary choices. Butland, B., Jebb, S., Kopelman, P., McPherson, K., Thomas, S., Mardell, J., & Parry, V. (2007) Foresight Tackling Obesities: Future Choices - Project Report. 2nd edn.Government Office for Science, Department of Innovation Universities and Skills. Department of Health (2009) Obesity [online] Available at: [Accessed on 13 September 2009]. Swift, J.A., Glazebrook, C. & Macdonald, I. (2006) Validation of a brief, reliable scale to measure knowledge about the health risks associated with obesity. Int. J. Obesity, 661-668. [ABSTRACT FROM AUTHOR]

The incidence of overweight and obesity in youth is rapidly escalating to epidemic proportions (WHO, 2004). Multi-component interventions have been highlighted as the treatment of choice (NICE, 2006) but the current evidence base is limited and many interventions have not been properly evaluated. The Carnegie International Camp (CIC), an annual, residential, multi-component weight management intervention, has been previously demonstrated to be effective across a range of health outcomes for overweight and obese children and adolescents (Gately et al., 2005). The current study aimed to review the continued effectiveness of the CIC programme through evaluation of the same range of health outcome parameters. Two hundred and ninety young people (aged 8-18 years) were recruited (UK and internationally) for the 2006-2008 CIC programmes. It was not possible to identify a control group or to obtain random samples due to the specific nature of the intervention. Anthropometric and psychological outcome variables were measured on the first (baseline) and last day of each participants stay, and repeated weekly. Outcome variables measured: weight, height, waist circumference, body composition, blood pressure, aerobic fitness and self esteem. Some participants attended successive CIC programmes; only data from participants' first programme attendance were included for analysis. To control for study attrition only complete data sets were included in the analysis. Independent t-tests were utilised to identify group differences at baseline between the participant cohort of the current study (2006-2008) and the 1999-2002 participant cohort evaluated by Gately et al. (2005). Repeated measures tested for the significance of pre-post intervention changes within and between cohorts. Analysis was conducted using SPSS v16.0 with P < 0.05 accepted as significant. The CIC programme and all subsequent analyses were granted full ethical approval by NHS Leeds West Teaching Hospital Research Ethics Committee. One hundred and ninety-three complete data sets were obtained (2006-2008); significant improvements ( P < 0.05) were attained across all outcome variables in this cohort. Comparison with Gately et al. (2005) findings revealed similar changes were achieved in both studies: Similarimprovements across outcome variables were achieved in both cohorts evaluated, demonstrating the continued acute efficacy of the CIC. Direct comparison between different interventions is difficult due to programme heterogeneity, but repetition of existing studies provides benefits such as increased sample size, reduces variation of results and increases confidence in the effects of the experimental factor being examined. The CIC continues to demonstrate an acute effectiveness in producing positive outcomes across a range of physiological and psychological variables associated with overweight and obesity in young people. Similarimprovements across outcome variables were achieved in both cohorts evaluated, demonstrating the continued acute efficacy of the CIC. Direct comparison between different interventions is difficult due to programme heterogeneity, but repetition of existing studies provides benefits such as increased sample size, reduces variation of results and increases confidence in the effects of the experimental factor being examined. The CIC continues to demonstrate an acute effectiveness in producing positive outcomes across a range of physiological and psychological variables associated with overweight and obesity in young people. Gately, P.J., Cooke, C.B., Barth, J.H., Bewick, B.M., Radley, D., & Hill, A.J. (2005) Children's residential weight loss programs can work: a prospective cohort study of short-term outcomes for overweight and obese children. Pediatrics , 73-77. National Institute for Health and Clinical Excellence. (2006) Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children. London: NICE clinical guidance 43. Retrieved February 10, 2009 from . World Health Organisation (2004) Obesity: Preventing and managing the global epidemic. Report of a WHO consultation on obesity. Geneva: WHO. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is a metabolic disorder of multifactorial aetiology which affects approximately 1.9 million adults in the UK. The incidence of type 2 diabetes is increasing with obesity levels, and treatment focuses on achieving and maintaining adequate blood glucose levels and weight management in order to reduce the risk of diabetic complications. As diabetes is progressive, blood glucose often becomes inadequate on maximal dose oral glucose lowering therapy and patients may eventually require insulin as third line therapy. Exenatide is an alternative to insulin; the first drug in the class of incretin mimetics which has been used at Darent Valley Hospital for the past 2 years. This study aimed to audit patient management against the 2009 NICE guidelines and to identify any health benefits following 6 months of Exenatide treatment. A convenience sample of 46 outpatients ( n = 27 male; n = 19 female) in the Dartford and Gravesham area who were or had been taking Byetta, according to a list supplied by the Diabetes team, was utilised for this audit. Patients' medical information was collected from the clinical record system 'Diabeta' and statistical analysis was carried out using SPSS (v17) to investigate changes in weight, body mass index (BMI) and HbA as a marker of drug efficacy (repeated measures ANOVA). Retrospective patient data was also utilised to assess compliance with the NICE guidelines for starting patients on Byetta and continuing treatment at 6 months. At baseline the sample had a mean age of 57 (10.7) years and were predominantly obese [mean BMI 38.8 (8.4) kg m] with poor blood glucose control [mean HbA1c 10.0 (1.2)%]. Mean time since diagnosis was 9 (3.7) years. Overall, a significant reduction in weight was seen after 6 months of treatment ( P < 0.001) with a mean weight loss of 2.8 kg (0.6). BMI was significantly lower after 6 months ( P < 0.001) with a mean reduction of 1.5 kg m (1.9). HbA was also significantly reduced after 6 months ( P < 0.001) with a mean reduction of 1.7% (1.5). Changes in weight, BMI and HbA were not significantly different between genders, time since diagnosis or age. The audit identified that the Diabetes team were following NICE guidelines for the majority of the time. When starting the drug, 100% of patients were commenced as a third line therapy, 96% of patients had a HbA≥7.5%, and 77% had a BMI ≥35 kg m. Eighty seven percent of patients had associated psychological or medical problems and 38% were started on Byetta due to occupational implications of insulin or to promote weight loss. Of those patients that continued the drug after 6 months, 60% had achieved the recommended 1% reduction in HbA and 89% had shown a 3% reduction in weight. After 6 months, Byetta therapy was associated with significant reductions in weight, BMI and HbA, which supports the findings of previous research (Buse et al., 2004; DeFronzo et al., 2005). This audit did not include a control group, and future studies could compare the outcomes of treatment with Byetta against outcomes after conventional treatment. The management of patients on Byetta followed the NICE guidance for the majority of the time. However, data for some patients was missing from 'Diabeta', suggesting that staff were not always recording information after each consultation with the patient. In future, a larger sample size would increase the validity of results, and future audits within the hospital could focus on record keeping. Buse J.B., Henry R.R., Han J. et al. (2004) Effects of exenatide (exendin-4) on glycaemic control over 30 weeks in sulfonylurea-treated patients with type 2 diabetes. Diabetes Care 27, 2628-2635. DeFronzo R.A., Ratner R.E., Han J. et al. (2005) Effects of exenatide (exendin-4) on glycaemic control and weight over 30 weeks in metformin-treated patients with type 2 diabetes. Diabetes Care, 1092-1100. National Institute of Clinical Excellence (NICE) (2009) Type 2 diabetes - newer agents (partial update of CG66). Available online from: [Accessed on August 2010]. [ABSTRACT FROM AUTHOR]

The rising issue of obesity is associated with increased risk of morbidity and mortality. The prevention and management of obesity has been problematic, due to its complex and multifaceted aetiology (Foresight, 2007). Lifestyle modification is essential for effective and sustainable weight loss, however high attrition rates are common (Foresight, 2007). The aim of this study was to systematically review the evidence for the effectiveness of lifestyle (diet and exercise) programmes, identifying the features of successful lifestyle weight management programmes, and to explore the experiences of individuals who have attended the Hammersmith Hospitals Lifestyle weight management programme, identifying aspects which promote and prevent successful completion of the programme. This study consisted of a systematic review and phenomenological observational study of the Hammersmith hospitals NHS trust Lifestyle weight management clinic. The systematic review involved searching four relevant scientific electronic databases: Medline, Embase, Psychinfo, Cochrane Library; 4314 titles, 346 abstracts and 113 full texts were screened. Eight studies met the predetermined search criteria (Dietitian delivered one to one lifestyle interventions with overweight or obese adults reporting weight change). This systematic review focused on clinically significant (≥5%) weight loss (NHS, 2006) as the measure of efficacy and success of lifestyle weight management programmes. The phenomenological observation involved the Lifestyle clinic; a 6 months individualised care package consisted of diet and exercise advice with behaviour change techniques and motivational interviewing, delivered by a dietitian, to promote overweight/obese adults to reduce weight. Purposeful sampling of patients, who had attended the clinic in the last 12 months, was conducted by contacting and requesting for volunteers. In-depth one-to-one interviews with six participants (four completers, two non-completers) were completed and analysed (Colaizzi, 1978) with the assistance of the computer software nVivo 8, which organised coded statements and themes identified. Ethical approval was given by St Mary's Research Ethics Committee, London. Three of the eight studies reviewed demonstrated ≥5% clinically significant weight loss. Key features of all three successful programmes, and not of the five unsuccessful programmes, included frequent weekly follow ups, compulsory supervised exercise and intense dietary counselling and exercise regimens. The phenomenological observation identified a variety of factors; key promoting factors included regular appointments, realistic targets, recognising responsibility, positive attitude and support from others and dietitian. A key inhibiting factor was difficulty with exercise. Limitations of the study were: the limited number of studies, the heterogeneous nature of the studies, and the restricted applicability of the studies of the review. Recruitment bias restricting ratio of completers to non-completers, limited sample size, and lack of participant validation of the results/conclusions limited the phenomenological observation. Furthermore it was questionable whether the interventions were sustainable; participants believed lack of support after the 6 months and difficulty exercising inhibited success. Recommendations for practice included continuous regular support, supplementary exercise programmes and optional group support; however practical implications involved are cost, time and resources. Further quantitative and qualitative research with greater samples would be essential to validate this study, ensure data saturation and evaluate weight management interventions. Colaizzi, P (1978). Psychological Research As a Phenomenologist Views It: 48-71. In existential phenomenological alternatives for psychology. Ed. M King and R Valle. New York: Oxford University Press. Foresight (2007). Tackling obesities: future choices. . [Accessed on 9 October 2009]. National Health Service (NHS) (2006). Care pathway for the management of overweight and obesity. [Accessed on 10 December 2009]. [ABSTRACT FROM AUTHOR]

Subjective Global Assessment (SGA) had been recommended by the Renal Association (Wright & Jones 2010) as an appropriate nutritional screening tool for the detection of malnutrition in haemodialysis (HD) patients. However, it has been criticised for being time consuming (Kondrup et al. 2003) and lacking sensitivity (Kalantar-Zadeh et al.1999). The Patient Generated Subjective Global Assessment (PG-SGA) requires the patient to complete part of the screening tool; thus reducing the amount of time the dietitian spends completing it. A recent pilot project showed that, compared to SGA, PG-SGA was able to distinguish significant differences between several independent measurements of nutritional status (demonstrating construct validity) (Hyam et al., 2010). In contrast the Malnutrition Universal Screening Tool (MUST) did not identify risk of malnutrition in HD patients. The aim of the current project was to assess a greater number and range of patients (with respect to nutritional status) using the three tools, in order to confirm whether PG-SGA was the most appropriate nutritional screening tool for use in HD patients. The nutritional status of 65 HD patients ( n = 43 male; n = 22 female) attending two renal units; St Georges and Canterbury, was assessed by one investigator at each unit (KF and RP respectively). There was no exclusion criteria, however investigators aimed to assess a greater proportion of patients with suspected malnutrition (identified by SN and SR) as this group was possibly under-represented in the previous study. Data included SGA, MUST, PG-SGA, grip strength, anthropometric and biochemical parameters. Construct validity was examined using ANOVA to compare differences between the nutritional values of those patients classified by the nutritional screening tools as being at no risk, moderate risk or high risk of malnutrition. Criterion validity was assessed using the kappa statistic to measure the level of agreement between SGA (as the gold standard), PG-SGA, and MUST. SGA classifications of nutritional status were able to distinguish significant differences in: Albumin ( P = 0.03); CRP ( P = 0.023), hand grip strength ( P = 0.001), average daily energy intake ( P = 0.005), protein intake ( P = 0.01) and haemoglobin ( P = 0.0001). PG-SGA only identified significant differences in hand grip strength ( P = 0.008) and mid arm circumference ( P = 0.024). MUST identified differences in current BMI ( P = 0.04), mid arm circumference ( P = 0.005) and CRP ( P = 0.03). A moderate kappa statistic (0.51) was recorded when comparing the level of agreement between PGSGA and SGA classifications of patients. Virtually no agreement was found between SGA and MUST (( = 0.07). The sensitivity of PG-SGA compared to SGA was 89% and the specificity was 50%. When MUST was compared to SGA the sensitivity was 31% and the specificity was 95%. The majority (63%) of patients were unable to complete the PG-SGA; which were then completed with the assistance of the investigators. MUST poorly identify malnourished HD patients (as found previously by Hyam et al., 2010). However in contrast to the pilot study, this current study which included a larger more nutritionally diverse group of patients, indicated that SGA was more sensitive to changes within independent nutritional parameters than PG-SGA. Over half the patients were not able to complete the PGSGA so, contrary to expectations, there were no time savings. SGA appears to be more sensitive to the nutritional status of HD patients than PG-SGA and additionally a large proportion of HD patients find PG-SGA too difficult to complete. MUST is not a sensitive method for detecting malnutrition in this group of patients. Hyam L., JacksonH., Hart K. & EngelB. (2010) Comparison of the new patient generated subjective global assessment with current established methods in haemodialysis patients. J. Hum. Nutr. Diet., 317-331 (abstract). Kalantar-Zadeh K., Don B. R., Rodriguez R. A. & Humphreys M. H. (2001) Serum ferritin is a marker of morbidity and mortality in haemodialysis patients. Am. J. Kidney Dis. , 564-572. Kondrup J., Allison S. P., Elia M., Vellas B. & Plauth M. (2003) ESPEN Guidelines for nutritional screening. Clin. Nutr. , 415-21. Wright M. & Jones C. (2010) Clinical practice guidelines; nutrition in Chronic Kidney Disease. Available online at: [Accessed on 6 August 2010]. [ABSTRACT FROM AUTHOR]

An abstract of the article "A retrospective audit of weight loss in bariatric surgery patients," by E. Cooper and L. Watson is presented.

The recruitment pattern of lower limb muscles during cycling is known to alter because of changes in workload and seat height. The effect of foot/pedal position is not well understood but may be useful in the prevention and management of injury. Seven healthy female subjects participated in a study. Three-foot positions on the pedal were tested in a random order: neutral, back and fore. Each subject cycled for 5 minutes at a set cadence and resistance during which 30 seconds of electromyogram data were recorded for gastrocnemius (Gast.) and tibialis anterior (TA). An electrogoniometer was located across the knee to concurrently record pedal revolutions. To test the effect of position, an ANOVA and Tukey's post-hoc were used for Gast. However, the data from the TA were not normally distributed; therefore, a Kruskal-Wallis was used for this muscle instead. No statistical significant relationship was found between foot position and TA activity ( p = 0.128). However, there was a significantly ( p = 0.000) lower level of activity in Gast. when the pedal was placed in the back foot position. Altering the position of the foot on a pedal changes the muscle activity of Gast. This is likely to be caused by the change in moment arm and may be exploited as a strategy to progress resistance during a training programme or as a method of protecting the muscle during a period of recovery. These conclusions should be interpreted with caution because of the small sample size. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]