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The non-proteinous amino acid L-theanine (L-THE) is associated with a range of health benefits including improvements in immune function, cardiovascular outcomes and cognition. The aims of this study were to develop a food product (mango sorbet; ms-L-THE) containing physiologically relevant doses of L-THE (0.2/100 g w/w) and determine its antioxidant, physicochemical and sensory properties in comparison to a mango sorbet without L-THE (ms). Total phenolic and flavanol content, and antioxidant analysis (DPPH, FRAP and ABTS) were determined spectrophotometrically. Both products were also evaluated for acceptability and likeability in healthy participants using the 9-point hedonic scale. Any differences that could be caused by the addition of L-THE were examined using the triangle test. Results indicated no significant differences between ms-L-THE and ms in taste of the products (p > 0.05), and the ms-L-THE was well received and accepted as a potential commercial product. Findings of the DPPH assay indicated significant difference between the two products (p

Arthritis is a significant cause of chronic pain and disability, affecting around 3.5 million Australians. However, little is known regarding the overall diet quality of those living with arthritis. This study aimed to assess the dietary quality of Australians living in the Australian Capital Territory region with arthritis. This cross-sectional study analysed dietary intake data of individuals living with arthritis using a validated food frequency questionnaire. Dietary quality was assessed using the Healthy Eating Index-2015 (HEI-2015) to examine associations between diet composition, age, income and arthritis impact using the short form of the Arthritis Impact Measurement Scales 2 (AIMS2-SF). Participants, predominantly female (82.6%), were grouped by age: 18–50 years (n = 32), 50–64 years (n = 31), and 65 + years (n = 23). Significant correlations were observed between age and HEI-2015 (rs = 0.337, p = 0.002) and income and AIMS2-SF (rs = − 0.353, p

Objective:The present study aimed to explore how healthy food choices are translated into everyday life by exploring definitions of healthy food choices, perceptions of own food choice, and healthy food choice drivers (facilitators) and barriers.Design:An exploratory qualitative study design was employed using semi-structured face-to-face interviews. Convenience sampling was used to recruit participants. Interviews were audio-recorded, transcribed verbatim and cross-checked for consistency. Thematic analysis was used to identify patterns emerging from the data.Setting:Canberra, Australia, October 2015–March 2016.Participants:A total of twenty-three participants aged 25–60 years were interviewed. The mean age was 38 years and the mean BMI was 29·1 kg/m2. All male participants (n4) were within the healthy weight range compared with 58 % of female participants, with 26 % being overweight and 16 % being obese.Results:(i) Healthy food choices are important but are not a daily priority; (ii) healthy eating information is known but can be difficult to apply into everyday life; (iii) popular diets are used in attempts to improve healthy eating; and (iv) social media inspires and connects people with healthy eating.Conclusions:Social media facilitates healthy food choices by providing access to healthy eating information. In addition to Facebook and Instagram, healthy eating blogs were highlighted as a source of nutrition information. Research should consider exploring the use of healthy eating blogs and whether these blogs can be used as a tool by dietitians to communicate procedural healthy eating information more effectively in the future.

OBJECTIVES: There are a growing number of people aged over 55 years living in retirement communities in Australia. These communities typically consist of accommodation, services and community facilities which cater to older people and the desire to maintain independence. The Nutrition and Healthy Ageing Trajectories in Retirement Living (NutriHAT-RL) study aims to investigate the nutrition and lifestyle-based behaviours which contribute to healthy ageing and the maintenance of social and physical functioning among older people living in retirement communities. METHODS: This study will recruit a total of 2,770 people aged 55 years or over living in retirement communities in the Australian Capital Territory and southern New South Wales regions of Australia for a four-year prospective longitudinal study commencing in March 2021. A range of measures, including nutritional intake, health and lifestyle behaviours, cognitive and psychological function, and physical health, will be completed on three occasions over a total of four years. Participants will complete a face-to-face comprehensive, validated food frequency questionnaire at each time point. Risk of malnutrition and nutritional behaviour (emotional appetite and intuitive eating) will also be evaluated. Multiple mental, social, and physical health domains will be assessed at each time point. This will include cognitive and mental health (depression, anxiety, and loneliness) screening, social and occupational functioning questionnaires, self-reported and observed physical function assessments, and sleep quality. Bitter taste endophenotype, salivary C-reactive protein, telomere length, and blood biomarkers associated with healthy ageing will also be evaluated. RESULTS: Ethics approval has been obtained through the University of Canberra Human Ethics Research Committee (UCHREC-2306). To reduce risk of COVID-19 transmissions, a risk mitigation plan has been developed. CONCLUSIONS: The NutriHAT-RL study will be the first Australian longitudinal study with a focus on nutrition and healthy ageing in people living in retirement communities. Findings from this study will contribute to understanding of nutrition and healthy ageing in this growing population and will inform policy and practice related to nutrition and ageing in place. FUNDING SOURCES: N/A.

Malnutrition poses a significant problem for oncology patients, resulting in fatalities within this population. Patients with head and neck cancer (HNC) are at high risk, with up to 90% developing malnutrition. Common treatments used for HNC can often lead to adverse side effects, including oral health conditions, gastrointestinal upsets, and several metabolic changes. Consequently, treatments can cause inadequate nutritional intake, resulting in a reduction in energy consumption, and alterations in energy utilization, contributing to the development of malnutrition. Furthermore, the presence of these treatment toxicities, and the related malnutrition can lead to reduced quality of life, weight loss, and psychological distress. There are interventions available (nutritional, medicinal, and physical therapies) that have demonstrated potential effectiveness in reducing the severity of symptomatic toxicities, reducing the risk of malnutrition, and improving survival outcomes of patients with HNC. Based on the findings of this review, there is an urgent need for the implementation or continuation of multi-disciplinary strategies, as well as updated and improved guidelines to assist in the prevention and treatment of malnutrition caused by treatment-related toxicities in patients with HNC.

Consumption of L-Theanine (L-THE) has been associated with a sensation of relaxation, as well as a reduction of stress. However, these physiological responses have yet to be elucidated in humans where L-THE is compared alongside food or as a functional ingredient within the food matrix. The aim of this study was to determine the physiological responses of a single intake of a potential functional food product (mango sorbet) containing L-THE (ms-L-THE, 200 mgw/w) in comparison to a flavour and colour-matched placebo (ms). Eighteen healthy male participants were recruited in this randomised, double-blind, placebo-controlled trial. The participants were required to consume ms-L-THE or placebo and their blood pressure (BP) (systolic and diastolic), heart rate (HR), and heart rate variability (HRV) were monitored continuously over 90 minutes. Eleven males (age 27.7 ± 10.8 years) completed the study. Changes in area under the curve for systolic and diastolic blood pressure and HRV over the 90 minute observation period indicated no differences between the three conditions (all p &gt, 0.05) or within individual groups (all p &gt, 0.05). The values for heart rate were also not different in the placebo group (p = 0.996) and treatment group (p = 0.066), while there was a difference seen at the baseline (p = 0.003). Based on the findings of this study, L-THE incorporated in a food matrix (mango sorbet) demonstrated no reduction in BP or HR and showed no significant parasympathetic interaction as determined by HRV high-frequency band and low-frequency/high-frequency ratio. Further studies should be focussed towards the comparison of pure L-THE and incorporation within the food matrix to warrant recommendations of L-THE alongside food consumption.

Aim The aim of this research was to evaluate a Consensus Model for competency-based assessment. Methods An evaluative case study was used to allow a holistic examination of a constructivist-interpretivist programmatic model of assessment. Using a modified-Delphi process, the competence of all 29 students enrolled in their final year of a Master of Nutrition and Dietetics course was assessed by a panel (with expertise in competency-based assessment; industry and academic representation) from a course e-portfolio (that included the judgements of student performance made by worksite educators) and a panel interview. Data was triangulated with assessments from a capstone internship. Qualitative descriptive studies with worksite educators (focus groups n=4, n=5, n=8) and students (personal interviews n=29) explored stakeholder experiences analysed using thematic analysis. Results Panel consensus was achieved for all cases by the third-round and corroborated by internship outcomes. For 34% of students this differed to the ‘interpretations’ of their performance made by their worksite educator/s. Emerging qualitative themes from stakeholder data found the model: (1) Supported sustainable assessment practices; (2) Shifted the power relationship between students and worksite educators, and; (3) Provided a fair method to assess competence. To maximise benefits, more refinement, resources and training are required. Conclusions This research questions competency-based assessment practices based on discrete placement units and supports a constructivist-interpretivist programmatic approach where evidence across a whole course of study is considered by a panel of assessors.

Folate has been proposed to be an efficacious treatment strategy for depression. The mandatory fortification of flour with synthetic folic acid (FA) in over 80 countries has yielded improvements in folate intake; however, depression is still a considerable public health concern. While there are established benefits of FA fortification in reducing risk of neural tube defects, the implications regarding depression are unclear, especially in individuals with certain genetic polymorphisms. Therefore, a systematic review was conducted to examine the effects of folate to treat depression. Following PRISMA guidelines, a systematic review was conducted of electronic databases (PUBMED, Scopus, CINAHL, and Cochrane Library) to identify human clinical trials examining the effects of folate (including FA) supplementation in the management or prevention of depression, the impact on inflammatory markers and if genetic polymorphisms were considered. Ten trials met the inclusion criteria. Seven trials examined effects of either adjunctive FA or L-methylfolate (L-MTHF) supplementation with antidepressants in the management of depression and three examined effects of FA supplementation alone for prevention of depression. No benefit of FA was found compared to placebo (all, p > 0.05). The single L-MTHF trial that explored the interplay of genetic polymorphisms and methylation status found benefit in the Hamilton depression rating scale from adjunctive treatment with 15 mg/day of L-MTHF compared with placebo (−6.8 ± 7.2 vs. −3.7 ± 6.5; p = 0.017) and improvement with L-MTHF for most genetic markers. Currently, there is no evidence to support FA supplementation for the management or prevention of depression. More research is required to determine the efficacy of L-MTHF and folinic acid in certain clinical populations.

The use of existing public spaces by people living with dementia, such as museums and art galleries, are becoming popular due to their ability to facilitate programs which promote social engagement and inclusion. However, few studies have investigated physiological outcomes of art gallery-based programs. Using a quasi-experimental design, the present study aimed to investigate the levels of salivary biomarkers of cortisol and interleukin-6, quality of life (QoL), depressive symptoms, cognition, and wellbeing, after attending the National Gallery of Australia (NGA) Art and Dementia program. Twenty-eight people living with dementia, each supported by a carer or family member, were recruited for a six-week program and were followed up at twelve weeks. In total, 25 participants (17 female; mean age 84.6±7.27 years) completed the study, and 22 provided viable saliva samples. The waking to evening salivary cortisol ratio was higher post-intervention (p = 0.033), and returned to baseline levels at follow-up (p = 1.00), indicating a more dynamic salivary cortisol rhythm in response to the six-week program. Interleukin-6 levels remained unchanged (p = 0.664). No improvements in QoL (DEMQOL-Carer) were observed between baseline and post-intervention (p = 0.076). However, self-reported depressive symptoms decreased post-intervention compared with baseline (p = 0.015), and memory (immediate recall) (p = 0.009) and verbal fluency (p = 0.027) improved between the same timepoints. The NGA Art and Dementia program appears to have quantifiable benefits, including improved hypothalamic-pituitary-adrenal axis function, justifying a need for longer controlled trial inclusive of physiological outcomes.

Background Blogs are widely being used by health professionals and consumers to communicate and access nutrition information. There are numerous benefits for dietitians to establish and contribute to healthy eating blogs. In particular, to disseminate evidence-based nutrition information to promote healthier dietary practices. The aim of this study was to explore characteristics of popular healthy eating blogs and inform the provision of healthy eating information in the Australian context. Methods A content analysis approach was used to identify characteristics of popular Australian healthy eating blogs. A purposive and snowball sampling approach was used to identify healthy eating blogs from search engines including Google, Bing and Yahoo. Blogs were deemed eligible if: (1) the author self-identified as a health professional; (2) the blog was written by a single author; (3) the blog was written by an Australian author; (4) the blog had a minimum of one post per month, and (5) the blog focused on communicating healthy eating information to the general adult population. Results Five popular blogs were followed over a three-month period (December 2017–March 2018), with 76 blog posts included for analysis. Characteristics of these popular blogs were examined and four main features were identified: (i) clearly conveying the purpose of each post; (ii) developing a strong understanding of the reader base and their preferences; (iii) employing a consistent writing style; use of vocabulary and layout; and (iv) communicating healthy eating information in a practical manner. These findings reveal important insight into the features that promote effective nutrition communication within this context. Conclusion Findings from this study highlight common characteristics of popular healthy eating blogs. Future research into the development of blog guidelines which incorporate the characteristics identified in this study can support dietitians in establishing or contributing to the successful provision of evidence-based nutritional information through blogs.

Several lifestyle parameters including diet, physical activity and sleep were associated in isolation with the presence of Metabolic Syndrome (MetS) in adults, to date there is a paucity of studies which evaluated their combined role aging populations and especially with respect to gender. Therefore, the aim of the present study was to provide a global consideration of the lifestyle factors associated with MetS among elderly individuals. Cross-sectional observational study. 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece. during 2005-2015, 2749 older (aged 65-100 years) from were voluntarily enrolled in the study. Dietary habits, energy intake, physical activity status, sociodemographic characteristics, lifestyle parameters (sleeping and smoking habits) and clinical profile aspects were derived through standard procedures. The presence of MetS was defined using the definition provided by NCEP ATP III (revised) and cluster analysis was used to identify overall dietary habit patterns. The overall prevalence of MetS in the study sample was 36.2%, but occurred more frequently in females (40.0% vs. 31.8%, respectively, p=0.03). Individuals with MetS were more likely to sleep during the day (89.4% vs. 76.8% respectively, p=0.039) and frequent ‘siesta’ was positively linked to the odds of MetS presence in females (Odds Ratio (OR) =3.43, 95% Confidence Intervals (CI): 1.08-10.9), but not for men (p=0.999). The lower carbohydrate (i.e., 45.2% of total daily energy, 120±16gr/day) dietary cluster was inversely associated with the odds for MetS presence, but only for men (OR=0.094, 95%CI: 0.010-0.883). Lifestyle parameters including sleep and diet quality are strongly associated with the presence of MetS in elderly cohort, but different their level of influence appears to be different, depending on gender. Further research is needed to better consider the role of lifestyle characteristics in the management of MetS in clinical practice.

BackgroundDigital story telling (DST) is an innovative way to allow students to assess the care needs of an older adult and creates an opportunity for interdisciplinary involvement. Traditionally, a single healthcare discipline approach is used by higher education institutions for preclinical training in the care of the older adult. Interprofessional learning (IPL) is generally not integrated well into the health professional curricula of Australian Universities.AimTo explore the use of Mask-Ed as a way of eliciting students understanding of their roles in patient care and to determine readiness for IPL in a cohort of health students prior to clinical placement.MethodAn online survey of students prior to their first clinical placement was undertaken. The survey incorporated a digital story of a Mask-Ed character and the readiness for IPL scale.ResultsStudents recognised the importance of IPL. However, only 25% of students had an advanced understanding of their own roles and no student showed an advanced understanding of the other disciplines roles in the care of the older adult.ConclusionsIn this study, DST using Mask-Ed assisted with students' understanding of interprofessional roles in the care of the older adult. Our findings demonstrated that IPL is important, and this was further enhanced by the use of Mask-Ed simulation.

Vitamin D deficiency has been identified as a worldwide issue with potential to adversely affect an individual's health. To date, no research has been conducted into the Vitamin D knowledge and practices of Australian Dietitians. The purpose of this study was to survey Dietitians on their knowledge and practices regarding Vitamin D intake, sources, supplementation, and affect on disease state. An online survey was disseminated to members of the Dietitians Association Australia (responses n = 134) via online national newsletters. Descriptive statistics were used to analyse the results. Where respondents made comments, answers were coded and placed into corresponding categories. Z‐scores were used to compare between responses. 29% of respondents identified that endogenous production contributes 90–100% of total Vitamin D. 42% of respondents correctly identified the recommendation of 10–15 minutes of sun exposure at low UV times to prevent deficiency. 31% of respondents correctly identified the cut‐off for mild deficiency, 20% for moderate deficiency, and 16% for severe deficiency. Approximately a third of respondents were unsure of the forms of Vitamin D supplements available or whether there were differences in potency. When asked about what their first‐line treatment for deficiency would be, 84% said supplements, 71% said increased sun exposure. Actual cases seen by respondents were treated by supplements (88%), and only 4% used increased sun exposure. Dietitians are well positioned to provide patients with advice on Vitamin D supplementation and sun exposure practices, but there is a need for clear and well‐disseminated guidelines for Vitamin D management by Dietitians.

Objectives To determine the proportion of Residential Aged Care Facilities (RACFs) in Australia who use a nutrition screening tool on residents to identify those at risk of malnutrition, and to review practice following identification of residents as being at high risk of malnutrition. Design Multi-center, cross sectional observational study. Setting: Residential Aged Care Facilities. Participants The Director of Nursing at each site was contacted by telephone and asked questions relating to current nutrition screening practices at their residential aged care facility. Measurements Data was collected from a stratified sample of 229 residential aged care facilities in each state and territory in Australia. Results 82% of RACFs (n = 188) use a nutrition screening tool on residents to identify those at risk of malnutrition, however only 52% of RACFs (n = 119) used a screening tool which is validated in the residential aged care setting. There was a significant association between facilities using a nutrition screening tool and the staff members being trained to conduct nutrition screening (p < 0.001). Facilities that employed a dietitian were more likely to use a validated nutrition screening tool (p < 0.005). The most frequently used nutrition screening tool was the ‘Mini Nutritional Assessment–Short Form (MNA-SF)’, which was used by 32% (n = 60) of the RACFs, followed by the ‘Malnutrition Universal Screening Tool (MUST)’ (15%, n = 29). Conclusion We found that the majority of RACFs in Australia use a nutrition screening tool, however many of these RACFs use a tool which has not been validated in the RACF setting. This study highlights the need for greater dietetic advocacy in using validated nutrition screening tools to ensure malnutrition is identified.

Assistive technology including virtual reality and augmented reality has gained interest as a novel intervention in a range of clinical settings. This technology has the potential to provide mental stimulation, a connection to autobiographical memory through reminiscence, and enhanced quality of life (QoL) to people living with dementia (PLWD) and mild cognitive impairment (MCI). In this mini-review, we examine the available evidence from studies reporting on the potential benefits of virtual and augmented reality to provide enjoyable, leisurely activities that may promote QoL and psychological well-being and facilitate social interaction. In total, 10 studies of varying study designs and durations (5 min to 6 months) using virtual (n = 9) and augmented reality (n = 1) were examined in PLWD (n = 6) and MCI (n= 3), in addition to 1 study that included participants with both conditions. Overall, the virtual experiences were enjoyed by the participants, improved their mood and apathy, and were preferred when compared with nonvirtual experiences. However, small sample sizes and variations in study design limit the generalizability of the results. Nevertheless, the use of virtual and augmented reality technology for PLWD and MCI is a novel and emerging method which may provide cognitive stimulation and improve well-being. Future research should explore the potential application of this technology to promote social interaction in both the community and aged care settings. We suggest future studies in PLWD and MCI assess the effects of more sustained use of virtual and augmented reality technology on psychological outcomes including QoL, apathy, and depressive symptoms, with the incorporation of physiological biomarker outcomes.

Nutraceuticals have generated interest as a way to mitigate the cognitive decline in older adults. The aim of this systematic review was to determine the evidence for these claims from the scientific literature in randomised, double-blinded, controlled trials (duration: ≥1 year; participants:n≥100; age(mean): ≥65 years). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched four electronic databases (PubMed, Scopus, CINAHL and Web of Science) and identified twenty-five studies published between the 15·June·2006 and 14·June·2016. Interventions included B-vitamins,n-3 fatty acids, antioxidant vitamins and herbs. Of the B-vitamin studies, four found benefits to cognition with supplementation. The first of these B-vitamin studies, in individuals with mild cognitive impairment (n266; duration=2 years), included benefit to executive function (P=0·015) and improvements in the Mini-Mental State Examination (MMSE) among participants with baseline homocysteine above 11·3 µmol/l (Pn-3 fatty acid status. The third B-vitamin study (n900; duration=2 years) reported improved performance in immediate (P=0·046) and delayed recall (P=0·013), whereas the fourth study (n856; duration=2 years) reported slower rate of cognitive decline in the MMSE (P=0·05). One study investigating DHA treatment (n402; duration=1·5 years) revealed the slower rate of cognitive change inapoE e4non-carriers (P=0·03). As only five included studies revealed notable benefits, presently based on the specific compounds explored here, there is not compelling evidence to support the use nutraceuticals to improve cognition in the elderly. Future long-term trials of nutraceuticals should investigate interactions with lifestyle, blood biomarkers and genetic risk factors.

Pre-clinical training is traditionally conducted in ‘siloed’ disciplines limiting inter-professional learning (IPL) opportunities. A pilot using Mask-EdTM technology was used to simulate an authentic IPL experience for health-care students and enhance the IPL experience of students in a preclinical simulation-training program. A multidisciplinary, simulated ward experience was conducted using Mask-EdTM. Students completed pre- and post-pilot Interprofessional Collaborative Competencies Attainment Surveys (ICCAS). A focus group was conducted to explore participant IPL experience and pre-clinical skill development. Statistically significant improvements were found in all six domains of the ICCAS (collaboration, roles and responsibilities, patient centred approach, conflict management and team functioning). Focus group analysis generated three themes: authenticity, mistakes are ok and learning. This pilot study suggests that Mask-Ed™ simulation is an effective method to teach IPL to health students.

Aim Competency standards are widely adopted as a framework to describe standards of performance required in the workplace. Little is known, however, about how students construct competence. This qualitative study aimed to explore how dietetics students ready to graduate construct the concept of competence and the role of assessment in developing professional competence. Methods A qualitative description was used to gather data from a convenience sample of students ready to graduate from universities with accredited dietetics programs across Australia (10 out of 15 at the time of the study). A total of 11 focus groups were conducted to explore perspectives of competence and experiences of ‘competency-based’ assessment. Data were audio-recorded, transcribed and analysed using a thematic analysis approach. Results A total of 81 (n = 81) participants across 10 universities representing 22% of total students participated in the focus groups. Themes revealed that: (i) there is no shared understanding of competence; (ii) current work placement experiences may not reflect current standards or workforce needs; (iii) assessment approaches may not fully support the development of competence; and (iv) the competent performance of supervising dietitians/clinical educators in the workplace influences the construction of competence. Conclusions There is a need to work towards a shared understanding of dietetic entry-level competence in the profession. ‘Work-based’ learning experiences may need to be modified to ensure students meet current competency standards. Practitioners involved in student supervision need to acknowledge the influential role they have in the development of the future workforce.

A healthy oral environment features a rapid turnover rate of epithelium cells capable of regeneration and repair, with the oral epithelium contributing as a physical barrier and immune defense. However, the oral cavity can be subjected to unique damage, such as ulcerations. Honey is reported as a therapeutic agent for wound healing, due to its antioxidant, antibacterial and anti-inflammatory properties.

Art gallery programs tailored to the needs of people living with dementia are becoming more popular worldwide. This study aimed to observe the effects of six consecutive weekly discussion-based small group visits to the National Gallery of Australia Art and Dementia program on the salivary cortisol (SC) diurnal rhythm, salivary interleukin-6, quality of life (QoL), depressive symptoms, and cognitive function. Twenty-five participants (17 female; mean age 84.6 ± 7.27 years) completed the study with data collection at baseline, post-intervention, and at a six-week follow-up. Statistical methods were selected based on data distribution. The waking to evening (WE) SC ratio was altered (p = 0.016) (Baseline: 1.35 (1.19, 1.64), Post-intervention: 1.72 (1.54, 1.96), Follow-up: 1.44 (1.22, 1.79)) in the 22 participants who provided viable saliva samples. The WE SC ratio was higher post-intervention compared with baseline (p = 0.011), indicating a more dynamic SC rhythm, but returned to baseline levels at follow-up (p = 0.020). Interleukin-6 levels were unchanged (p = 0.664). In the total sample, no improvements in QoL (Proxy) (p = 0.165) were observed. However, self-reported depressive symptoms differed (p = 0.006), decreasing post-intervention (2.00 (1.00, 2.00)) compared with baseline (3.00 (2.00, 4.50)) (p = 0.015), and verbal fluency was affected (p = 0.027), improving from baseline (2.00 (0.00, 3.00)) to post-intervention (2.00 (0.50, 4.00)) (p = 0.027). Art and Dementia programs appear to have quantifiable benefits, including improved hypothalamic-pituitary-adrenal axis function, justifying a longer controlled trial inclusive of physiological outcomes.

The rapid surge in the use of technology has revealed potential for smartphone applications to assist with management of chronic disease in aging populations. However, little data exists surrounding the daily use of a smartphone application by a clinical population of older adults. In the present study, 50 individuals (46 female) aged between 50 and 77 years (mean age=63.1 ± 7.67) and living with arthritis, were recruited to use a photoplethysmography-based commercially-available smartphone application (HRV4Training) to measure heart rate variability to assist with disease management. In total, 45 participants had access to compatible smartphones and were instructed on how to use the application within five minutes of waking for ten weeks (70 days). Six participants either withdrew from the study or were excluded due to technological issues. Of the compliant participants (n=39) their average use was 51.5 days (73.6%), with measurements taken at the incorrect time on 3.64 days (5.20%). The median use was 60 days. At the end of the study, 44.0% of participants reported finding the application helpful, and 43.9% as neither helpful or unhelpful in managing their condition. The findings highlight challenges associated with application-based interventions for older adults including smartphone compatibility issues with older models and attrition due to illness or technology issues. Future health based smartphone applications should consider the needs of older adults as users of this technology. The inclusion of features such as reminder messages, alerts or prompts, may promote user engagement and has the potential to improve self-management of health conditions in this population.

This article investigates the 1989 U.S. invasion of Panama using qualitative tests for diversionarywar proposed by another researcher, Ryan C. Hendrickson. The author finds that this use of force was likely a “type” of diversionary war, in that it was likely motivated by a need to solve “domestic political problems” rather than to achieve strategic goals. Several proposals to further develop qualitative tests for diversionary war are advanced.