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Gastric bypass surgery leads to significant and sustained weight loss and a reduction in associated health risks in individuals with severe obesity. While reduced energy intake (EI) is the primary driver of weight loss following surgery, the underlying mechanisms accounting for this energy deficit are not well understood. The evidence base has been constrained by a lack of fit-for-purpose methodology in assessing food intake coupled with follow-up studies that are relatively short-term. This paper describes the underlying rationale and protocol for an observational, fully residential study using covert, objective methodology to evaluate changes in 24-hr food intake in patients (n = 31) at 1-month pre-surgery and 3-, 12- and 24-months post-surgery, compared to weight-stable controls (n = 32). The main study endpoints included change in EI, macronutrient intake, food preferences, and eating behaviours (speed, frequency, and duration of eating). Other physiological changes that may influence EI and weight regulation including changes in body composition, circulating appetite hormones, resting metabolic rate, total energy expenditure and gastrointestinal symptoms were also evaluated. Understanding which mechanisms contribute to a reduction in EI and weight loss post-surgery could potentially help to identify those individuals who are most likely to benefit from gastric bypass surgery as well as those that may need more targeted intervention to optimise their weight loss post-surgery. Furthermore, clarification of these mechanisms may also inform targeted approaches for non-surgical treatments of obesity.

The development of spatial planning and management approaches is required to increase the space available for aquaculture production and to support the increasing global demand for food resources. During a European funded project, a large consultation exercise highlighted that stakeholder involvement is a necessity for successful planning and must be a continuous process as part of the development of a decision-making tool. In this study we present a decision support tool built on a web based dynamic interface to Geographic Information Systems which facilitates access to information related to site selection, environmental interactions and management in aquaculture. It is derived from the AkvaVis concept and uses interactive functions that instantly display the results of spatial parameters chosen by the user. We adapted the tool for use within four case studies which deal with very different scales of aquaculture and issues related to aquaculture in four different countries. The key strengths of our tools relate to their capacity to manage and display spatial data from different sources in a transparent way, the ability to use and display a series of built-in indicators, and the long-term development potential made possible by the maintenance strategy of the tools, services and data depository. Consultations and meetings provided an accurate view of stakeholder expectations as well as feedback on the tool development and applicability, therefore helping the tool to meet the prerequisite for operational decision-making tools.

Summary Gastric bypass surgery is an effective long‐term treatment for individuals with severe obesity. Changes in appetite, dietary intake, and food preferences have all been postulated to contribute to postoperative body weight regulation, however, findings are inconsistent. The aim of this systematic review was to evaluate the current literature on changes in dietary intake and appetite following gastric bypass surgery, in the context of the methodology used and the analysis, interpretation, and presentation of results. Four databases were systematically searched with terms related to “gastric bypass surgery,” “appetite,” and “dietary intake,” and 49 papers (n = 2384 patients after gastric bypass) were eligible for inclusion. The evidence indicated that only a reduction in overall energy intake and an increase in postprandial satiety are maintained beyond 6‐month post‐surgery, whereas relative macronutrient intake and premeal hunger remain unchanged. However, available data were limited by inconsistencies in the methods, analysis, presentation, and interpretation of results. In particular, there was a reliance on data collected by subjective methods with minimal acknowledgment of the limitations, such as misreporting of food intake. There is a need for further work employing objective measurement of appetite and dietary intake following gastric bypass surgery to determine how these mechanisms may contribute to weight regulation in the longer term.

Marine aquaculture is the most promising industry for ensuring future provision of seafood. Yet, the worldwide growth and expansion of this industry have been slower than expected, calling for the identification of environmentally suitable sites while accounting for all factors that could constrain or benefit its establishment. Here, we determine the main obstacles and risks hindering the growth and expansion of marine aquaculture, as well as the needs and recommendations to overcome such constraints. Our analysis is based on results obtained from a consultation process held in 16 study sites located around the world with the participation of 614 stakeholders representing the research community, aquaculture industry, government, conservation groups, and education and fishermen associations. A high level of commonality exists in the main issues hindering aquaculture growth and expansion in coastal, off-the-coast and offshore aquaculture with most being attributed to interactions with other maritime activities, including conflicts with other users and administrative procedures, including licensing. Critical needs for improved management and expansion of the aquaculture industry are related to planning andmanagement of developments and technological advances, with economic and market needs featuring to a lesser extent. Key procedures recommended to assist further aquaculture growth are th standardisation and simplification of regulatory frameworks, improvement of governance, and the adoption of participatory processes to facilitate meaningful and productive stakeholder engagement. We strongly recommend stakeholder participation to enhance insights on the full environmental and human dimensions of marine management and for implementation of ecosystem-based marine spatial planning.

Gastric bypass surgery (GB) is a successful treatment for obesity(1). Following the procedure, patients report changes in preference away from palatable high fat (HF), high sugar (HS) foods that may contribute to weight loss(2). The aim of this work is to examine the relationship between changes in reported ‘liking’ (hedonic) and ‘wanting’(motivation) for HF, HS food and 24hr dietary intake post-GB. 15 GB patients (BMI: 41.7 ± 11.54kg/m2, 73% female) and 15 time-matched controls (BMI: 25.08 ± 4.37 kg/m2, 73% female) were recruited as part of a larger residential study and observed for 3 days at each of 3 time points; 1-month pre-surgery, 3-months post-surgery and 1 yr post-surgery. Covert, objective assessment of 24hr dietary intake was on day 2 of each visit using weighed food records. Participants had ad-libitum access to foods pre-determined by food preference questionnaires and proportionally represented by 6 macronutrient groups (HF/HS, HF/high CHO, HF/high protein, low fat/HS, low fat/high CHO, low fat/high protein). ‘Liking’ and ‘wanting’ was measured using the Leeds Food Preference Questionnaire (LFPQ)(3), a validated measure that uses visual analogue scales to determine explicit liking and wanting for food. Implicit preferences are determined using response and reaction time in a forced-choice task. GB patients significantly reduced their overall energy intake (EI) from baseline to three months (-6.9 ± 8.1MJ/d p = > 0.001) and 1 yr post-surgery (-5.3 ± 7.5MJ/d, p = 0.01) compared to controls. At 3mths post-GB, there was no significant relationship between changes in preference for HS food and changes in %EI from sugar (R2 = 0.97, F(3,26) = 0.94 p = 0.44) or from HS foods (R2 = 0.87, F(3,26) = 0.83, p = 0.49). Changes in preferences for HF food at 3mths post-surgery were not significantly related to %EI from fat (R2 = 0.16, F(3,26) = 1.66, p = 0.2) or HF food (R2 = 0.18, F(3,26) = 0.16, p = 0.93). These associations remained at 1 yr post-surgery. In conclusion, previous observations based on self-reported food intake have found changes in preference for HF, HS food that may contribute to weight loss in GB. In contrast, our results show no significant relationship between changes in preference and changes in dietary intake post-surgery. Further research using direct, objective measures of dietary intake is needed to elucidate further changes in dietary intake post-GB.

BACKGROUND: Neuropathic pain is a consequence of damage to the central nervous system (CNS), for example, cerebrovascular accident, multiple sclerosis or spinal cord injury, or peripheral nervous system (PNS), for example, painful diabetic neuropathy (PDN), postherpetic neuralgia (PHN), or surgery. Evidence suggests that people suffering from neuropathic pain are likely to seek alternative modes of pain relief such as herbal medicinal products due to adverse events brought about by current pharmacological agents used to treat neuropathic pain. This review includes studies in which participants were treated with herbal medicinal products (topically or ingested) who had experienced neuropathic pain for at least three months. OBJECTIVES: To assess the analgesic efficacy and effectiveness of herbal medicinal products or preparations for neuropathic pain, and the adverse events associated with their use. SEARCH METHODS: We searched CENTRAL and the Cochrane Database of Systematic Reviews, MEDLINE, Embase, CINAHL and AMED to March 2018. We identified additional studies from the reference lists of the retrieved papers. We also searched trials registries for ongoing trials and we contacted experts in the field for relevant data in terms of published, unpublished or ongoing studies. SELECTION CRITERIA: We included randomised controlled trials (including cross‐over designs) of double‐blind design, assessing efficacy of herbal treatments for neuropathic pain compared to placebo, no intervention or any other active comparator. Participants were 18 years and above and had been suffering from one or more neuropathic pain conditions, for three months or more. We applied no restrictions to language or gender. We excluded studies monitoring effects of isolated, single chemicals derived from the plant or synthetic chemicals based on constituents of the plant, if they were not administered at a concentration naturally present within the plant. We excluded studies monitoring the effects of traditional Asian medicine and Cannabinoids as well as studies looking at headache or migraine as these treatments and conditions are addressed in distinct reviews. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Two review authors independently considered trials for inclusion, assessed risk of bias, and extracted data. We calculated the risk ratio (RR) and number needed to treat for an additional beneficial outcome (NNTB). The primary outcomes were participant‐reported pain relief of 30%, or 50%, or greater, and participant‐reported global impression of clinical change (PGIC). We also collected information on adverse events. We assessed evidence using GRADE and created a 'Summary of findings' table. MAIN RESULTS: We included two studies (128 participants). Both diabetic neuropathy and non‐diabetic neuropathic pain conditions were investigated across these two studies. Two herbal medicinal products, namely nutmeg (applied topically as a 125 mL spray for four weeks, containing mace oil 2%, nutmeg oil 14%, methyl salicylate 6%, menthol 6%, coconut oil and alcohol) and St John's wort (taken in capsule form containing 900 μg total hypericin each, taken three times daily, giving a total concentration of 2700 mg for five weeks). Both studies allowed the use of concurrent analgesia. Both reported at least one pain‐related outcome but we could not carry out meta‐analysis of effectiveness due to heterogeneity between the primary outcomes and could not draw any conclusions of effect. Other outcomes included PGIC, adverse events and withdrawals. There were no data for participant‐reported pain relief of 50% or greater or PGIC (moderate and substantial) outcomes. When looking at participant‐reported pain relief of 30% or greater over baseline, we observed no evidence of a difference (P = 0.64) in response to nutmeg versus placebo (RR 1.12, 95% confidence interval (CI) 0.69 to 1.85; 48.6% vs 43.2%). We downgraded the evidence for this outcome to very low quality. We observed no change between placebo and nutmeg treatment when looking at secondary pain outcomes. Visual analogue scale (VAS) scores for pain reduction (0 to 100, where 0 = no pain reduction), were 44 for both nutmeg and placebo with standard deviations of 21.5 and 26.5 respectively. There was no evidence of a difference (P = 0.09 to 0.33) in total pain score in response to St John’s wort compared to placebo, as there was only a reduction of 1 point when looking at median differences in change from baseline on a 0 to 10‐point numeric rating scale. There was a total of five withdrawals out of 91 participants (5%) in the treatment groups compared to six of 91 (6.5%) in the placebo groups, whilst adverse events were the same for both the treatment and placebo groups. We judged neither study as having a low risk of bias. We attributed risk of bias to small study size and incomplete outcome data leading to attrition bias. We downgraded the evidence to very low quality for all primary and secondary outcomes reported in this review. We downgraded the quality of the evidence twice due to very serious limitations in study quality (due to small study size and attrition bias) and downgraded a further level due to indirectness as the included studies only measured outcomes at short‐term time points. The results from this review should be treated with scepticism as we have very little confidence in the effect estimate. AUTHORS' CONCLUSIONS: There was insufficient evidence to determine whether nutmeg or St John's wort has any meaningful efficacy in neuropathic pain conditions. The quality of the current evidence raises serious uncertainties about the estimates of effect observed, therefore, we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

It has been estimated, on a global scale, that a limb is lost every 20 s due to diabetes. Effective treatment has, however, been shown to reduce the risk of amputations and foot ulcers. Self-management and the provision of effective foot care in the clinic and at home, is viewed as instrumental in providing appropriate care for people with diabetes. This in turn can reduce the costs associated with treating and managing diabetes and its associated complications. This paper presents a usability evaluation of a smartphone based solution for the management of diabetic foot disease. The solution combines novel thermal imaging with tailored educational content and gamification elements in an attempt to improve self-management of the condition. The solution was evaluated in a workshop setting by 7 participants. Overall, the participants felt the proposed solution would be a very worthwhile endeavor. They rated the usability and utility at an acceptable level (SUS 69.1/100). Notable suggested improvements focused on how educational content was formatted and searched in addition to the physical support provided to facilitate imaging of the feet.

Low back pain (LBP) has high lifetime prevalence with nonspecific LBP representing the majority of cases.(1) Relapses in pain (60%) and work absences (33%) are common,(1) making LBP one of the most costly conditions in the United Kingdom (total cost of £STG12,300 million, with the cost of informal care and production losses related to LBP contributing £STG10,668 million of this total figure).(2) Current research evidence supports the use of exercise- based treatment approaches for chronic low back pain (CLBP; pain persisting for at least 12 wk); in the United Kingdom, supervised group-based exercise programs are recommended, along with advice to stay physically active.(3) There is no specific guidance on how to self-direct participants to maintain or increase their physical activity (PA), although Savigny et al(3) refer to the National Institute for Clinical Health and Excellence (NICE) guidance on methods to increase PA.(4) One of the interventions identified in this review (NICE, 2006), was pedometer-driven walking, which can incorporate features considered important for increasing PA, that is, professional guidance, self-direction, and on-going professional support.(5) The evidence to support walking in people with CLBP is promising(6,7); however, it is not yet clear what approach works best. Hartvigsen et al(8) showed that supervised Nordic walking was as effective as unsupervised Nordic walking, and a trial by some of the current research team(9) is currently investigating the effects of a structured walking program according to ACSM guidelines (30 min, 5 times/ wk). Other approaches for promoting PA have advocated the use of step targets driven by a pedometer, for example, 10,000 steps, which can be accumulated throughout the day in bouts of at least 10 minutes, and where 3000 steps approximates to 30 minutes of walking.(10) It is not clear whether such an approach would be suitable for people with LBP, for example, in terms of how many steps they should or could accumulate, and what risks might be associated with this approach for this clinical population. No trial to date has investigated the use of a pedometer driven walking program in people with CLBP.(7) Therefore as a first step, before implementing a main RCT, we designed a preliminary study to test the feasibility of delivering a pedometer-driven walking program as an adjunct to a standard education/advice session in people with CLBP.(11) Our specific objectives were to: Assess recruitment and adherence rates in education/ advice (E) and education/advice plus pedometer-driven walking program (EWP) groups. Determine the incidence of adverse events (AEs), including musculoskeletal injuries, and level of overall satisfaction in both groups. Make between and within group comparisons and estimate effect sizes for changes in functional disability, PA levels, stage of change, fear avoidance, self-efficacy, health-related quality of life, psychosocial beliefs, general health, and participant satisfaction.

Reason for withdrawal from publication At August 2016, this protocol has been withdrawn due to the full review not meeting the quality standards and expectations of Cochrane and the PaPaS review group.

The number of persons living with chronic conditions such as Chronic Obstructive Pulmonary Disease, Dementia and Stroke is projected to continue to rise in the decades ahead. One emerging approach to reducing the consequent socio-economic burdens is the self-management paradigm whereby a patient is empowered through education, goal setting, measurement and quantification of health metrics, and feedback. This empowerment enables a patient to effectively manage their own long-term conditions. Here we present the current generic data models for educational content provision, setting goals and recording measurements utilised in the KeepWell self-management technology platform. We provide implementation details for each component and consequently identify areas of future work.

Background Current evidence supports the use of exercise-based treatment for chronic low back pain that encourages the patient to assume an active role in their recovery. Walking has been shown it to be an acceptable type of exercise with a low risk of injury. However, it is not known whether structured physical activity programmes are any more effective than giving advice to remain active. Methods/Design The proposed study will test the feasibility of using a pedometer-driven walking programme, as an adjunct to a standard education and advice session in participants with chronic low back pain. Fifty adult participants will be recruited via a number of different sources. Baseline outcome measures including self reported function; objective physical activity levels; fear-avoidance beliefs and health-related quality of life will be recorded. Eligible participants will be randomly allocated under strict, double blind conditions to one of two treatments groups. Participants in group A will receive a single education and advice session with a physiotherapist based on the content of the 'Back Book'. Participants in group B will receive the same education and advice session. In addition, they will also receive a graded pedometer-driven walking programme prescribed by the physiotherapist. Follow up outcomes will be recorded by the same researcher, who will remain blinded to group allocation, at eight weeks and six months post randomisation. A qualitative exploration of participants' perception of walking will also be examined by use of focus groups at the end of the intervention. As a feasibility study, treatment effects will be represented by point estimates and confidence intervals. The assessment of participant satisfaction will be tabulated, as will adherence levels and any recorded difficulties or adverse events experienced by the participants or therapists. This information will be used to modify the planned interventions to be used in a larger randomised controlled trial. Discussion This paper describes the rationale and design of a study which will test the feasibility of using a structured, pedometer-driven walking programme in participants with chronic low back pain. Trial Registration [ISRCTN67030896]