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Objective: The school food environment (SFE) is an ideal setting for encouraging healthy dietary behaviour. We aimed to develop an instrument to assess whole-SFE, test the instrument in the school setting and demonstrate its use to make food environment recommendations., Design: SFE literature and UK school food guidance were searched to inform instrument items. The instrument consisted of (i) an observation proforma capturing canteen areas systems, food presentation and monitoring of food intake and (ii) a questionnaire assessing food policies, provision and activities. The instrument was tested in schools and used to develop SFE recommendations. Descriptive analyses enabled narrative discussion., Setting: Primary schools., Participants: An observation was undertaken at schools in urban and rural geographical regions of Northern Ireland of varying socio-economic status ( n 18). School senior management completed the questionnaire with input from school caterers ( n 16)., Results: The instrument captured desired detail and potential instrument modifications were identified. SFE varied. Differences existed between food policies and how policies were implemented and monitored. At many schools, there was scope to enhance physical eating environments ( n 12, 67 %) and food presentation ( n 15, 83 %); emphasise healthy eating through food activities ( n 7, 78 %) and increase parental engagement in school food ( n 9, 56 %)., Conclusions: The developed instrument can measure whole-SFE in primary schools and also enabled identification of recommendations to enhance SFE. Further assessment and adaptation of the instrument are required to enable future use as a research tool or for self-assessment use by schools.

Dietary patterns (DP) rich in plant foods are associated with improved health and reduced non-communicable disease risk. In October 2021, the Nutrition Society hosted a member-led conference, held online over 2 half days, exploring the latest research findings examining plant-rich DP and health. The aim of the present paper is to summarise the content of the conference and synopses of the individual speaker presentations are included. Topics included epidemiological analysis of plant-rich DP and health outcomes, the effects of dietary interventions which have increased fruit and vegetable (FV) intake on a range of health outcomes, how adherence to plant-rich DP is assessed, the use of biomarkers to assess FV intake and a consideration of how modifying behaviour towards increased FV intake could impact environmental outcomes, planetary health and food systems. In conclusion, although there are still considerable uncertainties which require further research, which were considered as part of the conference and are summarised in this review, adopting a plant-rich DP at a population level could have a considerable impact on diet and health outcomes, as well as planetary health.

Background: The evidence base for the role of dietary protein in maintaining good muscle health in older age is strong; however, the importance of protein source remains unclear. Plant proteins are generally of lower quality, with a less favourable amino acid profile and reduced bioavailability; therefore, it is possible that their therapeutic effects may be less than that of higher quality animal proteins. This review aims to evaluate the effectiveness of plant and animal protein interventions on muscle health outcomes., Methods: A robust search strategy was developed to include terms relating to dietary protein with a focus on protein source, for example dairy, meat and soy. These were linked to terms related to muscle health outcomes, for example mass, strength, performance and sarcopenia. Five databases will be searched: MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Embase and Web of Science. Studies included will be randomised controlled trials with an adult population (≥ 18) living in the community or residential homes for older adults, and only English language articles will be included. Two independent reviewers will assess eligibility of individual studies. The internal validity of included studies will be assessed using Cochrane Risk of Bias 2.0 tool. Results will be synthesised in narrative format. Where applicable, standardised mean differences (SMD) (95% confidence interval [CI]) will be combined using a random-effects meta-analysis, and tests of homogeneity of variance will be calculated., Discussion: Dietary guidelines recommend a change towards a plant-based diet that is more sustainable for health and for the environment; however, reduction of animal-based foods may impact protein quality in the diet. High-quality protein is important for maintenance of muscle health in older age; therefore, there is a need to understand whether replacement of animal protein with plant protein will make a significant difference in terms of muscle health outcomes. Findings from this review will be informative for sustainable nutritional guidelines, particularly for older adults and for those following vegan or vegetarian diets., Systematic Review Registration: PROSPERO CRD420201886582., (© 2022. The Author(s).)

Background: Evidence suggests that dietary intake of UK children is suboptimal. As schools provide an ideal natural environment for public health interventions, effective and sustainable methods of improving food knowledge and dietary habits in this population must be identified. Project Daire aimed to improve children's health-related quality of life, wellbeing, food knowledge and dietary habits via two multi-component interventions., Methods: Daire was a randomised-controlled, factorial design trial evaluating two interventions across four arms. Primary schools in Northern Ireland were randomised to one of four 6-month intervention arms: i) 'Nourish', ii) 'Engage', iii) 'Nourish' and 'Engage' and iv) Control (Delayed). 'Nourish' was an intervention aiming to alter the whole-school food environment, provide food-related experiences and exposure to locally produced foods. 'Engage' was an age-appropriate, cross-curricular educational intervention on food, agriculture, nutrition science and related careers. Primary outcomes were emotional and behavioural wellbeing and health-related quality of life. A number of secondary outcomes, including dietary intake, cooking competence and food-related knowledge, were also measured., Results: Fifteen schools from areas of varying socio-economic status participated in the randomised trial. A total of 903 (n = 445 aged 6-7 years and n = 458 aged 10-11 years) primary school pupils took part. Total Difficulties Score improved in all pupils (6-7 and 10-11 year old pupils) who received the 'Nourish' intervention compared with those that did not (adjusted difference in mean = - 0.82; 95% CI -1.46, - 0.17; P < 0.02). No statistically significant difference in Health-Related Quality of Life was observed. The 'Nourish' intervention also produced some changes in school-based dietary behaviour, which were most apparent in the 10-11 year old pupils. The 'Nourish' intervention also produced improvements in understanding of food labels (adjusted difference in mean = 0.15; 95% CI 0.05, 0.25; P < 0.01) and knowledge of vegetables in season (adjusted difference in mean = 0.29; 95% CI 0.01,0.56; P = 0.04) whilst an increased willingness to try new foods and improved perceived cooking competence was also observed., Conclusions: Improvements in childhood emotional and behavioural wellbeing, dietary intake, knowledge about food, cooking skills and willingness to try new foods were associated with the 'Nourish' whole-school food environment intervention. Exploration of the sustainability and long-term effectiveness of such whole-school food interventions should be conducted., Trial Registration: National Institute of Health (NIH) U.S. National Library of Medicine Clinical Trials.gov (ID: NCT04277312 ).

Background: Learning cooking skills during childhood and adolescence is associated with positive dietary outcomes in adulthood as well as being tracked from adolescence to adulthood. In addition studies have found that perceived competence to be a greater motivator to perform a behaviour than actual competence. However, a lack of validated tools that effectively measure behavioural and dietary changes including cooking confidence in children is a limitation. Therefore, this research aimed to develop and validate age-appropriate perceived cooking competence measures for younger and older primary school aged children., Methods: Two measures of perceived Cooking Competence (CooC11 and CooC7) for older (8-12 years) and younger (6-7 years) children were developed from a critical evaluation of publically available recommendations and expert consultation. The cooking skills within the measures were illustrated by a graphic designer in consultation with a chef and reviewed in an iterative manner by the research team. The measures were piloted for clarity, ease of use and initial face validity. Multiple studies were used for both CooC11 and CooC7 to establish psychometric properties of the measures, temporal stability, internal consistency reliability, construct validity, as well as responsiveness to change for CooC11. Analysis included Exploratory Factor Analysis, Confirmatory Factor Analysis, Intraclass Correlation Coefficients, Pearson's Correlations, ANOVAs and Cronbach's Alphas., Results: Both measures had high levels of face validity and received positive user feedback. Two factors were shown in both measures with the measures showing excellent temporal stability (ICC > 0.9) and good internal consistency (Cronbach's Alphas > 0.7). Both measures showed initial discriminant validity, with significant differences (P< 0.001) between those who reported assisting their parents with dinner preparation and those who did not. Additionally, CooC11 was significantly correlated with an adult cooking measure and had a significant responsiveness to change (P< 0.01)., Conclusions: The CooC11 and CooC7 are the first validated age-appropriate measures for assessing children's perceived Cooking Competence for ages 8-12 and 6-7 years respectively. They can be used to evaluate the efficacy of children's cooking intervention studies or school nutrition education programmes.

At a constant power output, cyclists prefer to use a higher cadence than those that minimize metabolic cost. The neuromuscular mechanism underpinning the preferred higher cadence remains unclear., Purpose: The aim of this study was to investigate the effect of cadence on joint level work and vastus lateralis (VL) fascicle mechanics while cycling at a constant, submaximal, power output. We hypothesized that preferred cycling cadence would enhance the power capacity of the VL muscle when compared with a more economical cadence. Furthermore, we predicted that the most economical cadence would coincide with minimal total electromyographic activity from the leg muscles., Methods: Metabolic cost, lower-limb kinematics, joint level work, VL fascicle mechanics, and muscle activation of the VL, rectus femoris, biceps femoris, gastrocnemius medialis, and soleus muscles were measured during cycling at a constant power output of 2.5 W·kg and cadences of 40, 60, 80, and 100 rpm. A preferred condition was also performed where cadence feedback was hidden from the participant., Results: Metabolic cost was lowest at 60 rpm, but the mean preferred cadence was 81 rpm. The distribution of joint work remained constant across cadences, with the majority of positive work being performed at the knee. The preferred cadence coincided with the highest VL power capacity, without a significant penalty to efficiency, based on fascicle shortening velocity., Conclusions: Cycling at a higher cadence is preferred to ensure that the muscle's ability to produce positive power remains high. Further investigations are required to examine what feedback mechanism could be responsible for the optimization of this motor pattern.

Background: Gestational diabetes mellitus (GDM) is associated with a sevenfold increased lifetime risk of type 2 diabetes. Excessive gestational weight gain and postpartum weight retention are established predictors of long-term obesity., Objective: To determine the impact of a postnatal lifestyle intervention program for overweight women with previous gestational diabetes mellitus (PAIGE)., Design: Postnatal overweight women with previous GDM participated in a multicenter randomized controlled trial between June 2013 and December 2014. The intervention comprised a 1-hour educational program, a free 3-month referral to a commercial weight management organization (Slimming World), a pedometer, and structured telephone and text support, in addition to usual care. The control group received usual care only. The primary outcome was weight loss at 6 months., Results: Sixty women were randomized (29 intervention; 31 control) in two centers based on their week of attendance. The intervention group demonstrated significant weight loss at 6 months after randomization compared with the control group: mean ±SD, 3.9 ± 7.0 kg vs 0.7 ±3.8 kg (P = 0.02). Blood glucose levels did not significantly differ. With respect to well-being measures, a bodily pain was significantly reduced in the intervention group (P = 0.007)., Conclusions: PAIGE resulted in significantly greater weight loss at 6 months compared with usual care. Such weight loss could prove beneficial in terms of better long-term health and subsequent prevention of type 2 diabetes in overweight women with previous GDM. Future interventions must consider recruitment strategies, timing of the intervention, and inclusion of partners and/or other family members.

Background: Regular physical activity is important for maintaining physical and mental health. Benefits are optimized when physical activity is maintained. Understanding causal mechanisms is important to inform future interventions., Purpose: To investigate mediators of physical activity maintenance., Methods: Six databases were searched (Medline, EMBASE, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews, and Web of Science). Eligibility criteria included adult nonclinical populations, validated measure of physical activity behavior at baseline and at least 6 months postbaseline, control/comparison group(s), and reported mediators of physical activity behavior change. Mediators were examined according to (i) formal mediation tests, (ii) mediator association with physical activity outcome, and (iii) intervention effects on mediators., Results: There were few formal mediation tests conducted (n = 12/39 included studies), and various other methodological limitations were identified. There was some evidence that effective mediators in formal mediation tests at 6 months and later included the "behavioral processes of change" (n = 5/6). Many of the included interventions were not effective for changing targeted mediators (only 34% of 413 tests of mediator changes were significant)., Conclusions: There were a number of methodological and statistical limitations in the evidence base. In future, prespecified formal mediation tests should be carried out and could be aided by a formal framework. Social and environmental variables should be considered in addition to intrapersonal variables. Improving knowledge of how to change hypothesized mediators, based on theory and evidence, will reveal how physical activity behavior change maintenance can be achieved. Maintenance research would be enhanced by establishing a formal definition of behavior change "maintenance." PROSPERO registration: PROSPERO 2015:CRD- 42015025462.

The maximum force-generating capacity of a muscle is dependent on the lengths and velocities of its contractile apparatus. Muscle-tendon unit (MTU) length changes can be estimated from joint kinematics; however, contractile element length changes are more difficult to predict during dynamic contractions. The aim of this study was to compare vastus lateralis (VL) MTU and fascicle level force-length and force-velocity relationships, and dynamic muscle function while cycling at a constant submaximal power output (2.5 W/kg) with different cadences. We hypothesized that manipulating cadence at a constant power output would not affect VL MTU shortening, but significantly affect VL fascicle shortening. Furthermore, these differences would affect the predicted force capacity of the muscle. Using an isokinetic dynamometer and B-mode ultrasound (US), we determined the force-length and force-velocity properties of the VL MTU and its fascicles. In addition, three-dimensional kinematics and kinetics of the lower limb, as well as US images of VL fascicles were collected during submaximal cycling at cadences of 40, 60, 80, and 100 rotations per minute. Ultrasound measures revealed a significant increase in fascicle shortening as cadence decreased (84% increase across all conditions, P < 0.01), whereas there were no significant differences in MTU lengths across any of the cycling conditions (maximum of 6%). The MTU analysis resulted in greater predicted force capacity across all conditions relative to the force-velocity relationship ( P < 0.01). These results reinforce the need to determine muscle mechanics in terms of separate contractile element and connective tissue length changes during isokinetic contractions, as well as dynamic movements like cycling. NEW & NOTEWORTHY We demonstrate that vastus lateralis (VL) muscle tendon unit (MTU) length changes do not adequately reflect the underlying fascicle mechanics during cycling. When examined across different pedaling cadence conditions, the force-generating potential measured only at the level of MTU (or joint) overestimated the maximum force capacity of VL compared with analysis using fascicle level data.

Ultrasonography is a useful technique to study muscle contractions in vivo, however larger muscles like vastus lateralis may be difficult to visualise with smaller, commonly used transducers. Fascicle length is often estimated using linear trigonometry to extrapolate fascicle length to regions where the fascicle is not visible. However, this approach has not been compared to measurements made with a larger field of view for dynamic muscle contractions. Here we compared two different single-transducer extrapolation methods to measure VL muscle fascicle length to a direct measurement made using two synchronised, in-series transducers. The first method used pennation angle and muscle thickness to extrapolate fascicle length outside the image (extrapolate method). The second method determined fascicle length based on the extrapolated intercept between a fascicle and the aponeurosis (intercept method). Nine participants performed maximal effort, isometric, knee extension contractions on a dynamometer at 10° increments from 50 to 100° of knee flexion. Fascicle length and torque were simultaneously recorded for offline analysis. The dual transducer method showed similar patterns of fascicle length change (overall mean coefficient of multiple correlation was 0.76 and 0.71 compared to extrapolate and intercept methods respectively), but reached different absolute lengths during the contractions. This had the effect of producing force-length curves of the same shape, but each curve was shifted in terms of absolute length. We concluded that dual transducers are beneficial for studies that examine absolute fascicle lengths, whereas either of the single transducer methods may produce similar results for normalised length changes, and repeated measures experimental designs., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Physical activity (PA) interventions are generally effective in supporting short-term behaviour change, but increases are not always maintained. This review examined the effectiveness of PA interventions for behaviour change maintenance in young and middle-aged adults, and investigated which Behaviour Change Techniques (BCTs) and other intervention features were associated with maintenance., Methods: Six databases (Medline, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL, Web of Science) were systematically searched. Eligibility criteria were controlled trials investigating the effectiveness of PA interventions with adult (mean age 18-64 years) non-clinical populations using validated measures of PA behaviour at baseline and ≥six months' post-baseline. Results were pooled in meta-analyses using standardised mean differences (SMD) at five time intervals (6-9, 9-15, 15-21, 21-24, >24 months). Moderator analyses investigated the influence of sample and intervention characteristics on PA maintenance at 6-9 months., Results: Sixty-two studies were included. PA interventions had a significant effect on behaviour maintenance 6-15 months post-baseline relative to controls. Interventions had a larger effect on maintenance at 6-9 months (SMD = 0.28; 95% CI: 0.20, 0.35; I 2  = 73%) compared to 9-15 months (SMD = 0.20; 95% CI: 0.13, 0.26; I 2  = 70%). Beyond 15 months, PA measurements were infrequent with little evidence supporting maintenance. Moderator analyses showed some BCTs and intervention settings moderated PA outcomes at 6-9 months. A multivariable meta-regression model showed interventions using the BCTs 'Prompt self-monitoring of behavioural outcome' (b = 1.46, p < 0.01) and 'Use of follow-up prompts' (b = 0.38, p < 0.01) demonstrated greater effectiveness at promoting PA maintenance at 6-9 months. Interventions implemented in primary care (versus community or workplace/university) settings (b = -0.13, p = 0.10) tended to demonstrate less effectiveness., Conclusions: This review provides evidence of some effective BCTs for maintaining behaviour to 15 months. Greater consideration must be given to how future interventions encourage and measure maintenance of changes, and investigate broader psychological, social and environmental influences of PA behaviour., Prospero Registration: PROSPERO 2015:CRD42015025462., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Persistent organic pollutant (POP) exposure is strongly associated with negative health effects in humans. Heterocyclic aromatic amines (HAAs) are formed during high temperature cooking of foods (i.e. meat and fish). Human exposure to HAA is through food consumption and from similar food groups to POPs. A study of serum samples for POPs in a non-occupational exposed population (n = 149, age range 18-80 years, recruited in 2012) and comparison with estimated HAA daily intake calculations based on food diaries were undertaken. Three different age groups (group 1, 18-29 years; group 2, 30-44 years; and group 3, 45-80 years) were used to explore possible relationships between POP levels present in blood, HAA intake and nutritional cofactors. Significant differences (p < 0.05) between groups (1 and 3) for POP levels were found for p,p'-DDE, polychlorinated biphenyl (PCB) 153, PCB 138 and the sum of PCBs. A similar trend was found between groups 2 and 3 for PCB 153 and sum of PCBs. Significant differences were found between groups 1 and 3 and groups 2 and 3 for HAA intake., i.e. HAA intake was lowest in those of middle age, which may well reflect a different pathway of human exposure between HAA and POPs through the diet preferences.

Background: The influence of dietary fat upon breast cancer mortality remains largely understudied despite extensive investigation into its influence upon breast cancer risk., Objective: To conduct meta-analyses of studies to clarify the association between dietary fat and breast cancer mortality., Design: MEDLINE and EMBASE were searched for relevant articles published up to March 2012. Risk of all-cause or breast-cancer-specific death was evaluated by combining multivariable adjusted estimates comparing highest versus lowest categories of intake; and per 20 g increase in intake of total and/or saturated fat (g/day) using random-effects meta-analyses., Results: Fifteen prospective cohort studies investigating total fat and/or saturated fat intake (g/day) and breast cancer mortality were included. There was no difference in risk of breast-cancer-specific death (n = 6; HR = 1.14; 95% CI: 0.86, 1.52; p = 0.34) or all-cause death (n = 4; HR = 1.73; 95% CI: 0.82, 3.66; p = 0.15) for women in the highest versus lowest category of total fat intake. Breast-cancer-specific death (n = 4; HR = 1.51; 95% CI: 1.09, 2.09; p < 0.01) was higher for women in the highest versus lowest category of saturated fat intake., Conclusions: These meta-analyses have shown that saturated fat intake negatively impacts upon breast cancer survival.

Red meat consumption has been associated with negative health effects. A study to identify biomarkers of meat consumption was undertaken using serum samples collected from combining high resolution mass spectrometry (UPLC-QTof-MS) and chemometrics. Using orthogonal partial last-squares discriminant analysis (OPLS-DA), multivariate models were created for both modes of acquisition (ESI-/ESI+) and red meat intake classes (YES/NO). In the serum samples, a total 3280 and 3225 ions of interest were detected in positive and negative modes, respectively. Of these, 62 were found to be significantly different (p<0.05) between the two groups. Glycerophospholipids as well as other family lipids, such as lysophospholipids or sphingomyelin, were found significantly (p<0.05) different between yes and no red meat intake groups. This study has shown metabolomics fingerprints have the capability to identify potential biomarkers of red meat consumption, as well as possible health risk factors (e.g., key metabolic families related to the risk of development type 2 diabetes)., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Aims: The diagnosis of gestational diabetes mellitus (GDM) during pregnancy can lead to anxiety. This study evaluated the impact of an innovative patient-centred educational DVD on anxiety and glycaemic control in women newly diagnosed with GDM., Methods: 150 multi-ethnic women, aged 19-44years, from three UK hospitals were randomised to either usual care plus DVD (DVD group, n=77) or usual care alone (control group, n=73) at GDM diagnosis. Primary outcomes were anxiety (State-Trait Anxiety Inventory) and mean 1-h postprandial capillary self-monitored blood glucose for all meals, on day prior to follow-up., Results: No significant difference between the DVD and control group were reported, for anxiety (37.7±11.7 vs 36.2±10.9; mean difference after adjustment for covariates (95% CI) 2.5 (-0.8, 5.9) or for mean 1-h postprandial glucose for all meals (6.9±0.9 vs 7.0±1.2mmol/L; -0.2 (-0.5, 0.2). However, the DVD group had significantly lower postprandial breakfast glucose compared to the control group (6.8±1.2 vs 7.4±1.9mmol/L; -0.5 (-1.1, -<0.1; p=0.04)., Conclusions: The results in this trial did not highlight any differences between those who received the intervention and those who received usual care. It is possible that women already felt supported by their frequent attendance at specialist clinics for monitoring and advice. Healthcare professional and family support are key elements to empowering women with GDM and require further consideration in future interventions. Nonetheless, educational resources such as this will be beneficial to help support women given the current resource and time implications of the year on year rises in the incidence of gestational diabetes., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Humans naturally select a cadence that minimizes metabolic cost at a constant walking velocity. The aim of this study was to examine the effects of cadence on the medial gastrocnemius (MG) muscle and tendon interaction, and examine how this might influence lower limb energetics. We hypothesized that cadences higher than preferred would increase MG fascicle shortening velocity because of the reduced stride time. Furthermore, we hypothesized that cadences lower than preferred would require greater MG fascicle shortening to achieve increased muscle work requirements. We measured lower limb kinematics and kinetics, surface electromyography of the triceps surae and MG fascicle length, via ultrasonography, during walking at a constant velocity at the participants' preferred cadence and offsets of ±10%, ±20%, and ±30%. There was a significant increase in MG fascicle shortening with decreased cadence. However, there was no increase in the MG fascicle shortening velocity at cadences higher than preferred. Cumulative MG muscle activation per minute was significantly increased at higher cadences. We conclude that low cadence walking requires more MG shortening work, while MG muscle and tendon function changes little for each stride at higher cadences, driving up cumulative activation costs due to the increase in steps per minute., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Persistent organic pollutants (POPs) are distributed globally and are associated with adverse health effects in humans. A study combining gas chromatography-mass spectrometry (GC-MS), high resolution mass spectrometry (UPLC-QTof-MS) and chemometrics for the analysis of adult human serum samples was undertaken. Levels of serum POPs found were in the low range of what has been reported in similar populations across Europe (median 33.84 p, p'-DDE, 3.02 HCB, 83.55 β-HCH, 246.62 PCBs ng/g lipids). Results indicated that compounds concentrations were significantly different between the two groups of POPs exposure (high vs low) and classes (DDE, β-HCH, HCB, PCBs). Using orthogonal partial last-squares discriminant analysis (OPLS-DA), multivariate models were created for both modes of acquisition and POPs classes, explaining the maximum amount of variation between sample groups (positive mode R2 = 98-90%; Q2 = 94-75%; root mean squared error of validation (RMSEV) = 12-20%: negative mode R2 = 98-91%; Q2 = 94-81%; root mean squared error of validation (RMSEV) = 10-19%. In the serum samples analyzed, a total 3076 and 3121 ions of interest were detected in positive and negative mode respectively. Of these, 40 were found to be significantly different (p < 0.05) between exposure levels. Sphingolipids and Glycerophospholipids lipids families were identified and found significantly (p < 0.05) different between high and low POPs exposure levels. This study has shown that the elucidation of metabolomic fingerprints may have the potential to be classified as biomarkers of POPs exposure., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Increasing physical activity in the workplace can provide employee physical and mental health benefits, and employer economic benefits through reduced absenteeism and increased productivity. The workplace is an opportune setting to encourage habitual activity. However, there is limited evidence on effective behaviour change interventions that lead to maintained physical activity. This study aims to address this gap and help build the necessary evidence base for effective, and cost-effective, workplace interventions., Methods/design: This cluster randomised control trial will recruit 776 office-based employees from public sector organisations in Belfast and Lisburn city centres, Northern Ireland. Participants will be randomly allocated by cluster to either the Intervention Group or Control Group (waiting list control). The 6-month intervention consists of rewards (retail vouchers, based on similar principles to high street loyalty cards), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of participating workplaces will promote and monitor minutes of physical activity undertaken by participants. Both groups will complete all outcome measures. The primary outcome is steps per day recorded using a pedometer (Yamax Digiwalker CW-701) for 7 consecutive days at baseline, 6, 12 and 18 months. Secondary outcomes include health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of healthcare resources. Process measures will assess intervention "dose", website usage, and intervention fidelity. An economic evaluation will be conducted from the National Health Service, employer and retailer perspective using both a cost-utility and cost-effectiveness framework. The inclusion of a discrete choice experiment will further generate values for a cost-benefit analysis. Participant focus groups will explore who the intervention worked for and why, and interviews with retailers will elucidate their views on the sustainability of a public health focused loyalty card scheme., Discussion: The study is designed to maximise the potential for roll-out in similar settings, by engaging the public sector and business community in designing and delivering the intervention. We have developed a sustainable business model using a 'points' based loyalty platform, whereby local businesses 'sponsor' the incentive (retail vouchers) in return for increased footfall to their business., Trial Registration: ISRCTN17975376 (Registered 19/09/2014).

Heterocyclic aromatic amines (HCA) are carcinogenic mutagens formed during cooking of protein-rich foods. HCA residues adducted to blood proteins have been postulated as biomarkers of HCA exposure. However, the viability of quantifying HCAs following hydrolytic release from adducts in vivo and correlation with dietary intake are unproven. To definitively assess the potential of labile HCA-protein adducts as biomarkers, a highly sensitive UPLC-MS/MS method was validated for four major HCAs: 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP), 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx), 2-amino-3,4,8-trimethylimidazo[4,5-f]quinoxaline (4,8-DiMeIQx) and 2-amino-3,7,8-trimethylimidazo[4,5-f]quinoxaline (7,8-DiMeIQx). Limits of detection were 1-5 pg/ml plasma and recoveries 91-115%. Efficacy of hydrolysis was demonstrated by HCA-protein adducts synthesised in vitro. Plasma and 7-day food diaries were collected from 122 fasting adults consuming their habitual diets. Estimated HCA intakes ranged from 0 to 2.5 mg/day. An extensive range of hydrolysis conditions was examined for release of adducted HCAs in plasma. HCA was detected in only one sample (PhIP, 9.7 pg/ml), demonstrating conclusively for the first time that acid-labile HCA adducts do not reflect dietary HCA intake and are present at such low concentrations that they are not feasible biomarkers of exposure. Identification of biomarkers remains important. The search should concentrate on stabilised HCA-peptide markers and use of untargeted proteomic and metabolomic approaches., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Angiostrongylus vasorum infection is associated with high morbidity and mortality in dogs. Although recognised in Ireland, there are no large series of cases reported. The aim of this retrospective study was to identify pertinent clinical and geographical features in Irish dogs., Results: The case records of dogs presenting to the University College Dublin Veterinary Hospital (1999-2010) were reviewed. A contemporaneous review of external faecal parasitology and post mortem submissions was also performed. A positive diagnosis of angiostrogylosis was identified in 49 dogs including 24 clinical, 10 post mortem and 15 external faecal sample cases. The majority (n = 44 (90%)) resided on the East Coast.In the clinical cases, the median age was 20 months, 29% of cases were older than 2 years. Clinical features included cardiorespiratory (63%), coagulopathic (71%) and other (63%) signs. Cough (n = 10), dyspnoea (n = 5) and tachypnoea (n = 3) were the most common cardiorespiratory abnormalities. Of animals with evidence of coagulopathy, excessive haemorrhage from a wound (n = 5), airway haemorrhage (n = 9), epistaxis (n = 3), haematoma (n = 4), suspected haemarthrosis (n = 3), neurological signs (n = 2) and haematuria (n = 1) were found. Ten dogs were anaemic, of which two were severe (haematocrit ≤ 0.20 L/L). Ten animals had thrombocytopenia, with four severely affected (≤50 × 109/L). PT and APTT values were prolonged in 4 (24%) of 17 and a BMBT was prolonged in 5 (63%) of 8 cases. Vague signs of exercise intolerance (n = 6), lethargy (n = 6) and weakness (n = 2) were identified, with two (8%) animals having only these signs. In one animal the diagnosis appeared to be incidental. Thoracic radiographs (n = 19) identified abnormalities in 100% of cases. Four (17%) animals died before or within 24 hours of treatment and post mortem examinations confirmed angiostrongylosis. Fenbendazole was administered in 19 cases, 18 (95%) recovered. Two animals were euthanised, one which failed to respond to therapy and another in which an ante mortem diagnosis had not been made., Conclusions: Angiostrongylosis is not uncommon in Ireland, is not confined to young dogs or the East Coast and can present with a wide variety of signs, particularly coagulopathic, respiratory or neurological signs.

The clinical and clinicopathological features of non-suppurative meningoencephalitis in 30 greyhounds were reviewed. The dogs were from 21 separate litters, comprised both sexes (16 males and 14 females) and ranged in age from five to 18 months. In 14 (66.7 per cent) litters, more than one case was suspected or confirmed, and the number of siblings affected within individual litters ranged from one to seven. Clinical signs were progressive and varied from five days to 12 months in duration; 12 dogs had signs of two weeks' duration or less. The rate of progression of signs was variable. Common features included dullness or lethargy (22), altered behaviour (21), proprioceptive and postural reaction deficits (18), circling (17), ataxia (17), decreased appetite (15) and weight loss (13). No consistent haematological or biochemical abnormalities were identified and serology failed to implicate Toxoplasma gondii or Neospora caninum. Cerebrospinal fluid analysis revealed mild or moderate mononuclear pleocytosis in 12 (70.6 per cent) of 17 dogs. No definitive antemortem diagnosis could be made in any affected dog.

Background: Dietary patterns, which represent whole-diet and possible food and nutrient interactions, have been linked to the risk of various cancers. However, the associations of these dietary patterns with breast cancer remain unclear., Objective: We critically appraised the literature and conducted meta-analyses to pool the results of studies to clarify the relation between dietary patterns and breast cancer risk., Design: MEDLINE and EMBASE were searched for relevant articles that identified common dietary patterns published up to November 2009. Multivariable-adjusted odds ratios (ORs) comparing highest and lowest categories of dietary pattern scores and multivariable-adjusted ORs for a 20th-percentile increase in dietary pattern scores were combined by using random-effects meta-analyses., Results: Case-control and cohort studies were retrieved that identified prudent/healthy (n = 18), Western/unhealthy (n = 17), and drinker (n = 4) dietary patterns. There was evidence of a decrease in the risk of breast cancer in the highest compared with the lowest categories of prudent/healthy dietary patterns (OR = 0.89; 95% CI: 0.82, 0.99; P = 0.02) in all studies and in pooled cohort studies alone. An increase in the risk of breast cancer was shown for the highest compared with the lowest categories of a drinker dietary pattern (OR = 1.21; 95% CI: 1.04, 1.41; P = 0.01). There was no evidence of a difference in the risk of breast cancer between the highest and the lowest categories of Western/unhealthy dietary patterns (OR = 1.09; 95% CI: 0.98, 1.22; P = 0.12)., Conclusion: The results of this systematic review and meta-analysis indicate that some dietary patterns may be associated with breast cancer risk.

The existence of hypothyroidism in greyhounds remains controversial and its investigation is complicated by the low circulating thyroid hormone concentrations typically found in healthy dogs of this breed. Quantitative measurement of thyroidal technetium-99m pertechnetate ((99m)TcO4-) uptake is known to be useful in assessing thyroid function in other breeds. The aim of this study was to evaluate thyroid scintigraphy as a method of assessing thyroid function in greyhounds suspected of primary hypothyroidism. Twenty greyhounds (eight females, 12 males) were studied. Thirteen had bald thigh syndrome and seven poor performance and low total T4. Total T4 concentrations were decreased in 18 (90%), and free T4 in two (10%) dogs. All canine thyroid stimulating hormone concentrations were within the reference interval. Thyroidal (99m)TcO4- uptake values (mean +/- SD, 0.76 +/- 0.26%) were within the reference limits published for euthyroid dogs (0.39-1.86%) making hypothyroidism highly unlikely. There were no significant differences (P < 0.05) when comparing data between dogs with bald thigh syndrome (13 dogs) and the remaining dogs (seven dogs). Seventeen (85%) dogs had higher uptake in the left thyroid gland than in the right that might reflect an anatomic feature of the greyhound breed. Calculation of percent thyroidal uptake of (99m)TcO4- is more accurate than thyroid: salivary gland ratios because of high variability in salivary gland uptake. Percent thyroidal uptake of (99m)TcO4- should be used when assessing thyroid function scintigraphically in the greyhound breed.

Background: A liquid solution of levothyroxine (L-T4) is available for treatment of canine hypothyroidism., Hypothesis: Once daily oral administration of a liquid L-T4 solution is effective and safe for controlling hypothyroidism in dogs., Animals: Thirty-five dogs with naturally occurring hypothyroidism., Methods: Dogs received L-T4 solution PO once daily at a starting dosage of 20 microg/kg body weight (BW). The dose was adjusted every 4 weeks, based on clinical signs and peak serum total T4 (tT4) concentrations. Target peak serum tT4 and thyroid stimulating hormone (TSH) concentrations, 4-6 hours posttreatment, were 35-95 nmol/L and < 0.68 ng/mL, respectively. Dogs were followed for up to 22 weeks after establishment of the maintenance dose., Results: Clinical signs of hypothyroidism improved or resolved in 91% of dogs after 4 weeks of L-T4 treatment at 20 microg/kg once daily. The maintenance dose was established in 76, 94, and 100% of dogs after 4, 8, and 12 weeks of treatment, respectively. This was 20 microg L-T4/kg BW for 79% of the dogs, 30 microg/kg BW for 15%, and 10-15 microg/kg BW in the remaining 6%, once daily. Thereafter, median peak tT4 and TSH concentrations were 51 nmol/L and 0.18 ng/mL, respectively, and remained stable during the 22-week follow-up; clinical signs did not recur., Conclusions and Clinical Importance: All of the hypothyroid dogs had rapid clinical and hormonal responses to supplementation with the PO-administered L-T4 solution. The starting dosage of 20 microg L-T4/kg BW once daily was suitable for 79% of dogs.

Total thyroxine (T(4)) concentrations were below the non-breed-specific reference range in 42 of 46 healthy young greyhounds (91.3 per cent) and 16 (34.8 per cent) were at or below the limit of detection of the assay. Free T(4) concentrations were below the standard reference interval in 20.5 per cent of the animals and 13 per cent were at or below the limit of detection of the assay. In contrast, all the dogs' total tri-iodothyronine concentrations were within or above the non-breed-specific reference range and 67 per cent were within the upper half. All the dogs' thyroid stimulating hormone concentrations were within the non-breed-specific reference range. The results show that young greyhounds have markedly lower total and free T(4) concentrations than other breeds, and neither analyte can reliably be used to investigate the hypothyroidism in this breed as values were found below the limit of detection of each respective assay.

Background: Greyhound dogs have numerous clinicopathologic differences compared with other dog breeds, most notably in their hematologic profiles. The hematologic differences are likely related to breed; however, the influence of other factors, including age, sex, and training, has not been fully determined., Objectives: The aim of this study was to assess hematologic values in young, healthy, pretraining Greyhounds and to determine the effects of age and sex on these findings., Methods: Jugular venous EDTA-anticoagulated blood samples were collected from 43 healthy, pretraining Greyhounds between 5 and 13 months of age. Samples were analyzed within 24 hours of collection on an Abbott CELL-DYN 3500R hematology analyzer. Mean hematologic results for different age groups, and correlation with age and sex were determined for each analyte. Results were compared with adult canine, nonbreed-specific reference intervals., Results: From the age of 9 to 10 months, Greyhounds had higher HCT, hemoglobin concentration, and RBC counts compared with adult canine reference intervals. Younger Greyhounds (5-6 months) had values comparable with reference intervals. Mean total WBC, neutrophil, lymphocyte, and platelet counts tended to be toward the lower end or below the reference intervals. HCT, hemoglobin concentration, and RBC counts were correlated positively with age, and platelet count was correlated negatively with age. No differences were found based on sex., Conclusions: These results confirm that significant hematologic differences exist in pretraining Greyhounds by 9 to 10 months of age, when compared with adult canine, nonbreed-specific reference intervals; however, these differences are less marked in Greyhounds 5 to 6 months old. Given these findings, it is unlikely that factors such as training or racing are responsible for differences in hematologic values between adult Greyhounds and other breeds.

Objectives: To determine the ionised calcium concentration following aerobic collection of blood and to compare ionised calcium concentration and pH of heparinised whole blood and plasma at 48 hours following collection under three different storage conditions to assess if ionised calcium concentration can be measured retrospectively., Methods: Blood was collected from 17 dogs for analysis of ionised calcium concentration and pH using a Rapidpoint 400 (Bayer) blood gas analyser. Blood was collected into a commercial preheparinised syringe and into a plain syringe, with subsequent transfer to a commercially available heparinised sample tube. Samples were analysed within 10 minutes, and the remainder was divided for storage. One aliquot was set-aside at room temperature for 48 hours, and the other was immediately centrifuged and the plasma divided for storage at room temperature and at 4 degrees C for 48 hours each. In all samples, ionised calcium concentration and pH were measured again at 48 hours after storage., Results: There was no significant difference in ionised calcium concentration or pH between anaerobically and aerobically collected heparinised whole blood analysed within 10 minutes of collection. At 48 hours, ionised calcium concentrations had decreased under all storage conditions irrespective of the direction of pH change., Clinical Significance: Ionised calcium concentration can be measured in aerobically collected samples within 10 minutes and at 48 hours after collection under the conditions described.

Recent reports suggest that the canine heartworm Angiostrongylus vasorum is expanding from traditional endemic foci in several parts of the world. We are ill placed to judge the causes and potential consequences of this expansion because of a lack of knowledge about fundamental aspects of the biology of the parasite. We call for a renewed focus on this important but neglected nematode.

A six-year-old, female Tibetan terrier was referred for investigation of a non-healing wound on the left caudal thorax. A subcutaneous swelling had initially developed on the chest wall, followed by a draining tract from which seropurulent fluid drained for two months. There had been no response to antibiotic treatment. Following radiographic and ultrasonographic examinations, a bone sequestrum from a fractured rib or a foreign body was suspected. Surgical exploration of the wound identified a sinus tract and a wooden foreign body (an ice-lolly stick) was located in subcutaneous tissues. Partial wound dehiscence of the surgical site occurred postoperatively, but healed after 10 days. One month later, fluid began to discharge from the area again. Further surgical exploration confirmed a gastrocutaneous fistula. Dissection of the fistula and surgical closure of the stomach, body wall and skin led to resolution of all signs.

: Infection with Angiostrongylus vasorum was diagnosed at necropsy on a dog that died from acute pulmonary haemorrhage, and on recovery of L1 larvae by Baermann examination of faeces from two dogs, one of which had abdominal pain and retroperitoneal haemorrhage, while the other had right-sided heart failure due to cor pulmonale. The presenting signs included syncope (one dog), exercise intolerance (two dogs), cough (two dogs), abdominal pain (one dog) and depression (one dog). One-stage prothrombin time and activated partial thromboplastin time were prolonged in two dogs, buccal mucosal bleeding time was prolonged in one dog and globulin was elevated in all three dogs. Two dogs were treated with fenbendazole and recovered.