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ABSTRACT Introduction The term “Mediterranean lifestyle” has gained increasing prominence in recent years, yet a specific definition remains elusive. In response, the Mediterranean Lifestyle Medicine Institute Board of Directors convened a multidisciplinary panel comprising international experts and leaders in lifestyle medicine. Their goal was to review existing literature and formulate a consensus definition of the “traditional Mediterranean lifestyle (tMedL),” referring to the historical way of living of the people in the Mediterranean region. This paper presents the agreed consensus statement and a comprehensive holistic definition of the term “traditional Mediterranean lifestyle.” Methods Major medical and social sciences electronic databases from inception to February 2023 were searched, employing keywords relevant to the Mediterranean lifestyle and its constituent elements (diet, physical activity, sleep, stress, socialization). Subsequently, definitions for each pillar were created and synthesized to derive a comprehensive definition of the “traditional Mediterranean lifestyle.” Results This proposed definition received ratification from the Mediterranean Lifestyle Medicine Institute's expert working group during the First International Mediterranean Lifestyle Medicine Conference held in June 2023 on the island of Leros, Greece. “The traditional Mediterranean lifestyle is characterized by its diverse and adaptable nature. Key facets encompass conviviality, lifelong social connectedness, purposeful living, strong community and familial bonds, harmony with nature and the environment, profound spirituality, adherence to religious practices, preservation of local customs, resilience cultivated through adversity, and a commitment to moderation across all spheres of life.” Conclusions This definition comprehensively outlines the primary lifestyle factors ingrained in Mediterranean inhabitants across generations. Its holistic nature furnishes a crucial conceptual framework for directing lifestyle medicine practitioners in assisting patients to mitigate diseases, promote overall well‐being, devise research initiatives to investigate the health ramifications of this lifestyle, and inform curriculum development.

This paper presents the analysis and design of an isolated bidirectional DC-DC converter for applications where both input and output voltages may vary in a wide range. The proposed topology is derived from the integration of an isolated Current-Fed Dual-Active-Bridge (CF-DAB) stage with a Four-Switch Buck-Boost cell (4SBB), sharing one switching leg. Detailed design procedures are outlined for both CF-DAB and 4SBB stages, allowing to achieve Zero-Voltage turn-on of all devices while minimizing the inductor current RMS values. An optimized design of the CF-DAB coupled inductors allowed to achieve the desired leakage inductance value without the need for an additional magnetic component. Experimental results taken on a 5 kW prototype interfacing two voltage ports with VL ∈ [42 V, 72 V], VH ∈ [225 V, 435 V] validate the proposed design procedure.

Objectives: To assess the impact of medium-term supplementation with dihydrogen and pyrroloquinoline quinone (PQQ) on mitochondrial biomarkers, brain metabolism, and cognition in elderly individuals diagnosed with mild cognitive impairment. Design: A parallel-group, randomized, placebo-controlled, double-blind experimental design, maintaining a 1:1 allocation ratio between the experimental group (receiving the dihydrogen-producing minerals and PQQ) and the control group (receiving the placebo) throughout the trial. Setting and participants: Thirty-four elderly individuals with mild cognitive impairment (mean age 71.9 ± 3.8 years; 28 females) voluntarily provided written consent to participate in this trial. Participants were assigned in a double-blind parallel-group design to receive either a dihydrogen-PQQ mixture (Alpha Hope®, CalerieLife, Irvine, CA) or placebo twice daily for a 6-week intervention period. Methods: The primary endpoint was the change in serum brain-derived neurotrophic factor (BDNF) from baseline to the 6-week follow-up; secondary outcomes included cognitive function indices, specific metabolites in brain tissue, brain oxygenation, and the prevalence and severity of side effects. Interaction effects (time vs. intervention) were evaluated using two-way ANOVA with repeated measures and Friedman’s 2-way ANOVA by ranks, for normally distributed data with homogeneous variances and non-homogeneous variances, respectively. Results: Dihydrogen-PQQ resulted in a significant elevation in serum BDNF levels at the six-week follow-up (P = 0.01); conversely, no changes in BDNF levels were observed in the placebo group throughout the study duration (P = 0.27). A non-significant trend in the impact of interventions on BDNF levels was observed (treatment vs. time interaction, P = 0.14), suggesting a tendency for dihydrogen-PQQ to upregulate BDNF levels compared to the placebo. A significant interaction effect was observed for the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) scores in the orientation domain (P = 0.03), indicating the superiority of dihydrogen-PQQ over placebo in enhancing this cognitive aspect. Cerebral oxygenation saturation exhibited a significant increase following the administration of the dihydrogen-PQQ mixture, from 48.4 ± 7.2% at baseline to 52.8 ± 6.6% at 6-week post-administration (P = 0.005). In addition, brain N-acetyl aspartate levels significantly increased at seven out of thirteen locations post-intervention in participants receiving the mixture (P ≤ 0.05). Conclusions: Despite the limited number of participants included in the study for interpreting clinical parameters, the dihydrogen-PQQ mixture blend shows promise as a potential dietary intervention for enhancing mental orientation and brain metabolism in individuals with age-related mild cognitive decline.

Introduction: People with intellectual disability are less likely to participate in breast screening than people without intellectual disability. They experience a range of barriers to accessing breast screening, however, there is no consensus on strategies to overcome these barriers. Our objective was to reach consensus on the strategies required for accessible breast screening for people with intellectual disability. Methods: Fourteen experts participated in a modified on-line Delphi that used Levesque’s model of health care access as the theoretical framework. At the end of each round descriptive and thematic analyses were completed. Data was then triangulated to determine if consensus was reached. Results: After 3 rounds, 9 strategies were modified, 24 strategies were added and consensus was reached for 52 strategies across the 5 dimensions of access. Key areas of action related to (i) decision making and consent, (ii) accessible information, (iii) engagement of peer mentors, (iv) service navigators, and (v) equipping key stakeholders. Conclusions: The resulting strategies are the first to articulate how to make breast screening accessible and can be used to inform health policy and quality improvement practices.

While creatine is generally considered a safe dietary compound, there have been concerns about excessive creatine intake and its possible link to cancer. The main of this study was to examine the relationship between dietary creatine intake and cancer risk in the general US population using data from the 2017–2020 National Health and Nutrition Examination Survey (NHANES). We extracted a dataset that included information on medical conditions and dietary intake from 7,344 NHANES respondents. We used individual data files containing detailed information about each food and beverage item consumed to calculate creatine intake from meat- and milk-based food sources. In a subset of NHANES respondents who reported their cancer status, the average daily creatine intake was 11.6 ± 11.5 mg per kg body mass (95 % CI, 11.3 to 11.8); all participants in the subset were 20 years or older. Cancer-free individuals consumed significantly more creatine per day than those with cancer (11.7 ± 11.6 mg/kg body mass vs. 10.6 ± 10.2 mg/kg body mass; P = 0.01). The odds ratio for having cancer in the subset of participants consuming

BackgroundPolymerase chain reaction (PCR) testing for COVID-19 was crucial in Australia’s prevention strategy in the first 2 years of the pandemic, including required testing for symptoms, contact with cases, travel, and certain professions. However, several months into the pandemic, half of Australians were still not getting tested for respiratory symptoms, and little was known about the drivers of and barriers to COVID-19 PCR testing as a novel behavior at that time. ObjectiveWe aimed to identify and address COVID-19 testing barriers, and test the effectiveness of multiple eHealth interventions on knowledge for people with varying health literacy levels. MethodsThe intervention was developed in 4 phases. Phase 1 was a national survey conducted in June 2020 (n=1369), in which testing barriers were coded using the capability-opportunity-motivation-behavior framework. Phase 2 was a national survey conducted in November 2020 (n=2034) to estimate the prevalence of testing barriers and health literacy disparities. Phase 3 was a randomized experiment testing health literacy–sensitive written information for a wide range of barriers between February and March 2021 (n=1314), in which participants chose their top 3 barriers to testing to view a tailored intervention. Phase 4 was a randomized experiment testing 2 audio-visual interventions addressing common testing barriers for people with lower health literacy in November 2021, targeting young adults as a key group endorsing misinformation (n=1527). ResultsIn phase 1, barriers were identified in all 3 categories: capability (eg, understanding which symptoms to test for), opportunity (eg, not being able to access a PCR test), and motivation (eg, not believing the symptoms are those of COVID-19). Phase 2 identified knowledge gaps for people with lower versus higher health literacy. Phase 3 found no differences between the intervention (health literacy–sensitive text for top 3 barriers) and control groups. Phase 4 showed that a fact-based animation or a TikTok-style video presenting the same facts in a humorous style increased knowledge about COVID-19 testing compared with government information. However, no differences were found for COVID-19 testing intentions. ConclusionsThis study identified a wide range of barriers to a novel testing behavior, PCR testing for COVID-19. These barriers were prevalent even in a health system where COVID-19 testing was free and widely available. We showed that key capability barriers, such as knowledge gaps, can be improved with simple videos targeting people with lower health literacy. Additional behavior change strategies are required to address motivational issues to support testing uptake. Future research will explore health literacy strategies in the current context of self-administered rapid antigen tests. The findings may inform planning for future COVID-19 variant outbreaks and new public health emergencies where novel testing behaviors are required. Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12621000876897, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382318 ; Australian New Zealand Clinical Trials Registry ACTRN12620001355965, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380916&isReview=true

Abstract Background Single-cell RNA-sequencing is revolutionising the study of cellular and tissue-wide heterogeneity in a large number of biological scenarios, from highly tissue-specific studies of disease to human-wide cell atlases. A central task in single-cell RNA-sequencing analysis design is the calculation of cell type-specific genes in order to study the differential impact of different replicates (e.g. tumour vs. non-tumour environment) on the regulation of those genes and their associated networks. The crucial task is the efficient and reliable calculation of such cell type-specific ‘marker’ genes. These optimise the ability of the experiment to isolate highly-specific cell phenotypes of interest to the analyser. However, while methods exist that can calculate marker genes from single-cell RNA-sequencing, no such method places emphasise on specific cell phenotypes for downstream study in e.g. differential gene expression or other experimental protocols (spatial transcriptomics protocols for example). Here we present SMaSH, a general computational framework for extracting key marker genes from single-cell RNA-sequencing data which reliably characterise highly-specific and niche populations of cells in numerous different biological data-sets. Results SMaSH extracts robust and biologically well-motivated marker genes, which characterise a given single-cell RNA-sequencing data-set better than existing computational approaches for general marker gene calculation. We demonstrate the utility of SMaSH through its substantial performance improvement over several existing methods in the field. Furthermore, we evaluate the SMaSH markers on spatial transcriptomics data, demonstrating they identify highly localised compartments of the mouse cortex. Conclusion SMaSH is a new methodology for calculating robust markers genes from large single-cell RNA-sequencing data-sets, and has implications for e.g. effective gene identification for probe design in downstream analyses spatial transcriptomics experiments. SMaSH has been fully-integrated with the ScanPy framework and provides a valuable bioinformatics tool for cell type characterisation and validation in every-growing data-sets spanning over 50 different cell types across hundreds of thousands of cells.

This paper presents the analysis and design of an isolated bidirectional DC-DC converter for applications where both input and output voltages may vary in a wide range. The proposed topology is derived from the integration of an isolated Current-Fed Dual-Active-Bridge (CF-DAB) stage with a Four-Switch Buck-Boost cell (4SBB), sharing one switching leg. Detailed design procedures are outlined for both CF-DAB and 4SBB stages, allowing to achieve Zero-Voltage turn-on of all devices while minimizing the inductor current RMS values. An optimized design of the CF-DAB coupled inductors allowed to achieve the desired leakage inductance value without the need for an additional magnetic component. Experimental results taken on a 5 kW prototype interfacing two voltage ports with VL ∈ [42 V, 72 V], VH ∈ [225 V, 435 V] validate the proposed design procedure. [ABSTRACT FROM AUTHOR]

Sleep is a key biological mechanism in promoting wellbeing and resilience to stress. This cross‐sectional study examined connections between sleep, autonomic function, wellbeing, and stress reactivity in healthy individuals. Demographic, lifestyle, sleep, and psychological well‐being information were collected from 85 healthy university students. These variables were analysed in conjunction with indices of cardiac autonomic activity, including heart rate and high frequency heart rate variability (HF HRV, an indicator of parasympathetic vagal tone) recorded during nocturnal sleep onset and in response to a cognitive stressor. Correlational analyses revealed that unrefreshing and fragmented sleep was strongly associated with lower HF HRV at sleep onset, suggestive of poorer autonomic de‐arousal. Further, those with minimal increases in HF HRV from wakefulness to sleep reported worse sleep quality and greater challenges in daily activities compared to those with significant increases. This same group also demonstrated significantly greater reactivity and slower recovery when faced with a stressor the next day, as evidenced by comparison of heart rate values. Our findings suggest an association between autonomic hypervigilance and aspects of sleep quality, with potential implications for wellbeing and stress responses. [ABSTRACT FROM AUTHOR]

Author(s): Fiona F. Stanaway [sup.1] [sup.2] , Rosilene V. Ribeiro [sup.3] , Saman Khalatbari-Soltani [sup.1] [sup.2] , Erin Cvejic [sup.1] , Fiona M. Blyth [sup.1] [sup.2] , Vasi Naganathan [sup.4] [...], Background/objectives To compare the Australian Dietary Guideline Index (DGI-2013) and the Pyramid-based Mediterranean Diet Score (pyrMDS) as measures of diet quality in an ethnically diverse group of older men. Subjects/methods Seven hundred and ninety-four older men aged [greater than or equal to]75 participated in wave 3 (2012-2013) of the Concord Health and Ageing in Men Project. Dietary intake was assessed using a validated diet history questionnaire. Ethnicity was based on self-reported country of birth and categorised as Australian-born (418 men), Italian or Greek migrants (188), and other migrants (188). Incident cardiovascular outcomes until March 2018 were measured using the composite of major adverse cardiovascular events (MACE), which comprises all-cause mortality, acute myocardial infarction, congestive cardiac failure, coronary revascularisation and/or ischaemic stroke. Ability to predict incident cardiovascular outcomes and all-cause mortality were compared between standardised DGI-2013 pyrMDS scores by comparison of hazard ratios, discrimination (Harrell&apos;s C-statistic) and calibration (calibration plots). Results Italian and Greek migrant men had significantly lower DGI-2013 scores (91.7 vs. 93.9; p = 0.01) but significantly higher pyrMDS scores (8.8 vs. 8.2; p < 0.0001) than Australian-born men. In the whole sample (794 men), the pyrMDS was a better predictor of both MACE (age-adjusted HR = 0.84; 95% CI = 0.75-0.94 vs. HR = 0.92; 95% CI = 0.82-1.03 for DGI-2013) and all-cause mortality (age-adjusted HR = 0.69; 95% CI = 0.60-0.80 vs. HR = 0.86; 95% CI = 0.74-0.99). The pyrMDS also demonstrated superior discrimination for predicting all-cause mortality and superior calibration for MACE and all-cause mortality. Conclusions The DGI-2013 appears to underestimate diet quality in older Italian and Greek migrant men. The pyrMDS appears superior to the DGI-2013 for prediction of incident cardiovascular disease and mortality regardless of ethnic background.

Objectives To examine the sociodemographic and diagnostic factors associated with a discharge from hospital to residential aged care (RAC) for younger people (aged 15–64 years) with neuropsychiatric disorders.Design An exploratory case–control study using a historic cohort of people with neuropsychiatric disorders. Cases were people transferred to RAC on hospital discharge during the study period. Controls were people not transferred to RAC on discharge during the study period.Setting Public and private hospital admissions in New South Wales (NSW), Australia.Participants People aged 15–64 years with a neuropsychiatric disorder hospitalised in NSW between July 2002 and June 2015 (n=5 16 469).Outcome measures The main outcome was transferred to RAC on discharge from hospital. We calculated ORs for sociodemographic and diagnostic factors to determine factors that may impact discharge to RAC.Results During the period of data capture, 4406 people were discharged from hospitals to RAC. Discharge to RAC was most strongly associated with diagnoses of progressive neurological and cognitive disorders. Acute precipitants of RAC transfer included a broad range of conditions and injuries (eg, Wernicke’s encephalopathy, stroke, falls) in the context of issues such as older age, not being partnered (married or de facto), living in areas of lower socioeconomic status, functional issues and the need for palliative care.Conclusions There are multiple intersecting and interacting pathways culminating in discharge from hospital to RAC among younger people with neuropsychiatric disorders. Improved capacity for interdisciplinary home care and alternative housing and support options for people with high support needs are required.