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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]

Vegetables are commonly rejected by children, making it is important to consider factors that are associated with children's fussiness with vegetables. The current study aimed to investigate whether fussiness with vegetables is associated with a number of factors including caregiver and child vegetable consumption; caregivers' general feeding practices; and caregivers' vegetable-specific feeding practices. Caregivers ( N = 297) of preschool children completed questionnaire measures of their child's fussiness with vegetables, as well as several caregiver and child factors hypothesised to be associated with children's fussiness with vegetables. Findings indicate that children who are fussier with vegetables consume a smaller quantity of vegetables and that almost all have caregivers who eat a smaller quantity of vegetables. Children's fussiness with vegetables was not significantly related to any general feeding practices used by caregivers. However, children's fussiness with vegetables was significantly associated with the use of several vegetable specific feeding practices. Caregivers of fussier children used more encouragement/pressure to eat with vegetables ( r = 0.14, p = .01), hid vegetables within other foods more often ( r = 0.30, p = <.01), used more food rewards for vegetable consumption ( r = 0.19, p <.01), more other rewards for vegetable consumption ( r = 0.21, p < .01), and compromised more when feeding vegetables ( r = 0.14, p = .01). These findings suggest that rather than caregivers' general feeding practices being related to children's fussiness with vegetables, the specific feeding practices used when vegetables are rejected are more significant. It may therefore be helpful to develop advice for caregivers about which feeding practices to avoid when faced with a child who is fussy about eating vegetables. [ABSTRACT FROM AUTHOR]

Background In order to achieve metabolic stability, dietary treatment of inborn errors of metabolism may require restriction of protein, fat or carbohydrate. Manipulation of dietary intake potentially reduces micronutrient status, and provision of a comprehensive vitamin and mineral supplement becomes an essential adjunct to dietary treatment. Aim To review the efficacy of a new complete vitamin and mineral supplement [Fruitivits, Vitaflo Ltd] in 14 subjects in an open prospective 26-week study. Method All subjects had dietary restrictions: low protein diets (57%, n = 8), regular daytime cornstarch and overnight glucose polymer tube feeds (29%, n = 4), low fat diet (7%, n = 1) and modified Atkins diet (7%, n = 1). Plasma nutritional biochemistry, anthropometry and food frequency questionnaires were collected at week 0, 12 and 26 weeks respectively. Results Five nutritional parameters showed a significant improvement from baseline (week 0) to study end (week 26): folate ( P = 0.01), vitamin E ( P = 0.04), plasma selenium ( P = 0.002), whole blood selenium ( P = 0.04) and total vitamin D ( P = 0.008). All the other nutritional markers did not significantly change. Even with regular monitoring, 37% of the product remained unused. Conclusions Despite improvements in some nutritional markers, overall use of the vitamin and mineral supplement was less than prescribed. New methods are needed to guarantee delivery of micronutrients in children at risk of deficiencies as a result of an essential manipulation of diet in inborn disorders of metabolism. [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 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 Weight management interventions can be extended using mobile telephone technology to deliver support in real-time, real-world settings. The present study aimed to determine whether text messaging helped patients maintain or lose weight following a weight-loss programme. Methods In this controlled study, overweight and obese [ body mass index ( BMI) >30 kg m-2 or >28 kg m-2 with co-morbidities] adults who completed a weight-loss programme participated in an additional 12-week text message intervention [ Lifestyle, Eating and Activity Programme ( LEAP) Beep]. Patients were allocated goals for steps, fruit, vegetable and breakfast consumption. Patients regularly 'texted' their progress and received tailored practitioner feedback. Pre/post-intervention body weight, waist circumference ( WC), BMI, quality of life ( QOL), anxiety and depression measurements were compared retrospectively with a control group offered weight checks only. Results Compared to control ( n = 17), the intervention group's ( n = 17) body weight, WC and BMI reduced significantly (−1.6 versus 0.7 kg, P = 0.006; −2.2 versus 1.5 cm, P = 0.0005; −0.6 versus 0.7 kg m-2, P = 0.03, respectively). QOL and depression scores also improved (−6.8 versus 1 point, P = 0.134; −0.2 versus 0.2 points, P = 0.228). No difference was observed in anxiety scores between the groups. Intervention versus control group follow-up attendance improved significantly (4.4 versus 1.7 attendances, P = 0.0005). Conclusions LEAP Beep promoted losses in weight, WC and BMI, and improved QOL parameters and follow-up attendance. Text messaging is a cheap, portable, convenient and innovative medium facilitating goal setting, self-monitoring and information exchange. Further improvements to automation at the same time as maintaining individual support are necessary to ease practitioner burden. Text messaging offers cost-efficient dietetic input, opening up possibilities for practitioner-to-patient support and yields positive weight outcomes following initial weight loss. [ABSTRACT FROM AUTHOR]

Background Coeliac disease is an autoimmune disorder that is considered to affect approximately one in 100 people. In the UK, gluten-free (GF) foods can be prescribed by general practitioners ( GPs) to treat this condition and there are national guidelines on the quantities of GF food an individual should receive on prescription. Information on actual prescribing behaviour by GPs, and how this compares with guideline recommendations, is scarce. The present study aimed to describe GPs prescribing practice of GF foods, within one locality in the UK, comparing this with national guidelines. Methods A retrospective evaluation of GP electronic medical records for all patients with a gluten-sensitive enteropathy diagnosis and/or those prescribed GF food between April 2010 and March 2011 was carried out in 16 GP practices in the west of Scotland, serving a total of 85 667 patients. Results Of 175 (0.18% of the total practice population) patients, 152 were identified with coeliac disease, eight with dermatitis herpetiformis and six with both conditions. A further nine patients received GF foods on prescriptions with no recorded diagnosis. There was a positive association between adherence to the prescribing guidelines and female sex ( P < 0.0001) and (for those with a recorded diagnosis) increasing age ( P = 0.001). There was no significant association between either socio-economic deprivation or co-morbidities and adherence to the prescribing guidelines. Conclusions There was significant under prescribing of GF foods in those identified. Further research is required to establish whether these results are representative of wider practice in the UK. [ABSTRACT FROM AUTHOR]

Background Accurate estimates of energy expenditure are required in clinical nutrition in order to determine the requirements of individuals and to inform feeding regimes. Calorimetry can provide accurate measurements but is often impractical in clinical or community settings; prediction equations are widely used to estimate resting energy expenditure ( REE) but have limited accuracy. A portable, self-calibrating, handheld calorimeter ( HHC) may offer an alternative way of determining REE. The aim of the study was to evaluate whether estimates of REE derived using an HHC are closer to accurate measurements than values calculated using selected prediction equations. Methods REE was measured in 36 healthy adults aged 21-58 years using a flow-through indirect calorimeter ( FIC) and HHC. Estimated REE was calculated using three predictive equations ( Harris & Benedict; Schofield; Henry). Differences in REE between the 'gold standard' values derived using the FIC and those derived using the HHC and equations were examined using paired t-tests and Bland Altman plots. Results Mean REEHHC was significantly lower than mean REEFIC [4556 ± 1042 kJ (1089 ± 249 kcal) versus 6230 ± 895 kJ (1489 ± 214 kcal), P = 0.000] and also significantly lower than mean values calculated using all three equations. The mean difference between REEHHC and REEFIC [1674 ± 908 kJ (400 ± 217 kcal)] was significantly greater ( P = 0.000) than the mean differences between the values calculated using the three prediction equations [272 ± 490 kJ (65 ± 117 kcal) (Harris-Benedict), 264 ± 510 kJ (63 ± 122 kcal) (Schofield), 84 ± 502 kJ (20 ± 120 kcal) (Henry)]. Conclusions The HHC provides estimates of REE in healthy people that are less accurate than those calculated using the prediction equations and so does not provide a useful alternative. [ABSTRACT FROM AUTHOR]

Background Trainee dietitians, nutritionists, nurses and doctors will direct the future of obesity treatment and prevention. To do so effectively, they must be willing and able to engage empathically with overweight and obese people. The present study aimed to assess weight bias among UK trainee healthcare professionals and to investigate the factors predicting weight bias, both static and potentially modifiable. Methods A self-completed questionnaire collected data on demographics, weight and height, the Fat Phobia Scale ( F-scale), and the Beliefs about Obese People ( BOAP) scale from 1130 students. Results Overall, participants demonstrated significant levels of fat phobia [F-scale score mean ( SD) = 3.8 (0.5)]. Only 1.4% of participants could be said to have expressed 'positive or neutral attitudes' (i.e. achieved a F-scale score ≤ 2.5). Hierarchical multiple regression revealed that lower fat phobia (as measured by the F-scale) was uniquely predicted by a higher self-reported body mass index, being on the Nursing BSc course and a stronger perception that obesity is not under a person's control (as measured by the BOAP scale). Conclusions There are unacceptable levels of weight bias among UK students training to become nurses, doctors, nutritionists and dietitians. The results of the present study suggest that a promising approach for future interventions would be the provision of balanced education about the controllability of obesity, focusing upon genetic and environmental factors, as well as diet and exercise. [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]

International Journal of Paediatric Dentistry 2012; 22: 356-362 Background. In a randomized double-blinded clinical trial, preschool children used sucrose or xylitol chewing gum regularly for 2 months to study the preventive effect of xylitol on acute otitis media (AOM). Salivary m utans streptococci ( sm) levels of the children were measured before the exposure. Those with ≥105 sm CFU in 1 mL saliva were considered to have high sm levels ( sm+); and those with <105 CFU low sm levels ( sm−). Aim. This practice-based study aims to evaluate long-term dental effects of the sucrose/xylitol exposure on primary teeth. Design. For analyses, individuals were divided into sub groups according to their study group in the original AOM trial and baseline sm levels. Outcome events owing to dental caries of their all primary teeth were followed from dental records up to 12 years. Survival of teeth caries free was determined by Kaplan-Meier method and analysed statistically by Wilcoxon testing. Results. Survival of primary teeth caries free of children with high sm levels in the sucrose group was significantly shorter compared with all other groups when followed until shedding. Conclusions. Two months' regular exposure to sucrose was sufficient to induce dental caries in primary teeth of children with elevated sm levels at baseline. [ABSTRACT FROM AUTHOR]

Field CA, Gidley MD, Preshaw PM, Jakubovics N. Investigation and quantification of key periodontal pathogens in patients with type 2 diabetes. J Periodont Res 2012; 47: 470-478. © 2012 John Wiley & Sons A/S Background and Objective: Diabetes is a recognized risk factor for periodontitis. There are conflicting data regarding whether healthy diabetic patients or diabetic patients with chronic periodontitis have an altered subgingival microbiota compared with nondiabetic individuals. The aim of the present study was to detect quantitative differences in selected periodontopathogens in the subgingival plaque of diabetic patients using TaqMan quantitative PCR. Material and Methods: Type 2 diabetes mellitus patients with ( n = 9) or without chronic periodontal disease ( n = 15) were recruited and matched to nondiabetic control subjects ( n = 12 periodontally healthy, n = 12 chronic periodontitis). Subgingival plaque samples were collected from deep (> 4 mm probing depth) and shallow sites (≤ 3 mm probing depth) using paper points, and Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum and Porphyromonas gingivalis were quantified. Results: Forty-eight subjects (69 samples) were recruited. Marked differences were seen in the levels of all three bacterial species, relative to the total bacterial population, according to periodontal health status. Using real-time quantitative PCR, bacterial counts for P. gingivalis were significantly higher in deep pockets of diabetic and nondiabetic subjects compared with periodontally healthy subjects ( p < 0.05) but did not differ significantly between diabetics and nondiabetics. A. actinomycetemcomitans was detected in all groups in low quantities, and counts did not differ significantly between groups ( p > 0.05). F. nucleatum was abundant in all groups, with no clear significant differences between groups. P. gingivalis was found in higher quantities in periodontitis than in periodontally healthy subjects ( p < 0.05). Statistically significant positive correlations were identified between pocket depth and counts for all three species tested ( p < 0.05). Conclusion: A. actinomycetemcomitans, F. nucleatum and P. gingivalis were present in significantly different quantities and proportions in subgingival plaque, according to periodontal disease status. No significant differences were identified between the subgingival microbiota of type 2 diabetes mellitus patients compared with nondiabetic subjects. [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]

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 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]

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]