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To investigate: (1) the injury epidemiology in an Australian academy; (2) how athletes transition through the high-performance sport (HPS) pathway; and (3) why athletes leave this HPS program. This retrospective cohort study was conducted at an Australian HPS academy over a 4-year period. Medical attention injuries were prospectively recorded. Injury incidence rates (IIR) and burden were calculated per 365 athlete-days, according to sport, sex, and pathway level. Athlete pathway levels were mapped to the Foundations, Talent, Elite, and Mastery (FTEM) framework. Reasons for athletes transitioning out were reported. Four hundred and eighty-one injuries were reported across 124 athletes at an IIR of 2.09 injuries per 365 athlete-days (95% CI = 1.91-2.29). Most athletes (103, 83.1%) were injured at least once over the 4-year period. IIRs increased (IRR = 1.17, 95% CI = 1.06-1.29, p = 0.001) as athletes progressed through the pathway. The most common reason for athlete attrition was deselection due to performance (n = 18), with 55.6% of these athletes sustaining an injury in the season prior to deselection. Injury burden was highest at E2 (119.5 days absence per 365 athlete-days (95% CI = 62.18-229.67)) and lowest at T4 (30.47 days absence per 365 athlete-days (95% CI = 21.98-42.24)). Injury occurrence is common across HPS, with IIRs increasing as athletes progressed to higher talent levels. Deselection due to poor performance was the main attrition factor, with more than half the deselected athletes impacted by injury prior to deselection. This study highlights an increased risk of deselection, following injury, and indicates the need for further development of prevention strategies targeting pathway athletes., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Interoception refers to the ability to sense internal bodily sensations. Research suggests that dysfunctions in interoception may be implicated in the transition to chronic pain, however, little work has examined interoceptive ability in pain states. Therefore, this systematic review aimed to assess whether interoception is altered in individuals experiencing pain. Following a systematic search of 4 electronic databases from inception to February 2023, 28 studies were included. Outcomes of interoceptive accuracy, interoceptive sensibility, and interoceptive awareness were meta-analysed. The risk of bias was assessed, and the certainty of the evidence was evaluated. Meta-analyses indicated that those with chronic pain display reduced interoceptive accuracy and increased interoceptive sensibility. Subgroup analyses indicated that the change in interoceptive sensibility is dependent on the measure used, with those with chronic pain scoring higher on measures focusing on attention to bodily sensations, while also scoring lower on emotional reactivity. No difference in interoceptive awareness was observed between individuals with chronic pain and pain-free controls. Only one study was found that measured interoception in those experiencing acute pain, while another study recruited those experiencing recurrent pain. These findings suggest that while those with chronic pain self-report as more interoceptively aware, they are less accurate at detecting internal bodily signals. Further research investigating domains of interoception in those experiencing acute and recurrent pain is needed. Data should be interpreted with caution as the certainty of evidence was very low for all completed analyses. This review was registered on the PROSPERO International Prospective Register of Systematic Reviews (Registration ID = CRD42022318843). PERSPECTIVE: This review considered the relationship between interoception and pain and found that an individual's ability to accurately sense internal signals is decreased in those with chronic pain, despite them reporting being more aware of internal sensations. However, there remains little research examining interoception in non-chronic pain states., (Copyright © 2024 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed to build on previous work by the authors. It examines how socioecological level and gender influence high-performance sport system (HPSS) stakeholders' perspectives of the relative importance and feasibility to address athlete attrition factors within an Australian high-performance pathway system (HPPS)., Design: Mixed methods., Methods: Sub-analysis was conducted of rating data from 30 participants who had contributed to identifying 83 statements in 13 clusters in a previous Concept Mapping study. The 13 clusters were statistically analysed in 'R' using cumulative link mixed models (CLMMs) to determine differences in perceived importance and feasibility between 1) socioecological levels, and 2) genders., Results: Mean ratings for 11 and three of the 13 clusters were statistically significantly different between at least two of the five socioecological levels, for importance and feasibility, respectively. Athletes had the largest variation in mean ratings from the most (athlete health 4.59), to least (performance potential 2.83) important cluster, when compared to the other four socioecological levels. There were statistically significant differences between the ratings between genders (Men/Women) for two clusters for each rating scale: Importance: 'athlete health' (M3.33:W3.84 [p 0.012]); 'performance potential' (M3.35:W2.57; [p 0.001]), Feasibility: 'abuse and mismanagement of health' (M2.97:W3.68; [p 0.000]) and 'athlete health' (M2.54:W3.33; [p 0.000])., Conclusions: This study highlights the need to implement more robust athlete attrition monitoring protocols. It also highlights the importance of listening to youth athletes' voices, and enabling equal gender representation to ensure holistically tailored environments are created to retain talented athletes in high-performance pathway programmes., Competing Interests: Declaration of interest statement MD and RA worked at an Australian Institute of Sport; and KM and SG worked at the NSW institute of Sport at the commencement of this study. These institutes did not influence or approve the final version of this manuscript. No other conflict of interests to declare., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: Primary: To gain a system-wide perspective on factors leading to athlete attrition from a high-performance sport system (HPSS). Secondary: To identify what a sample of system-wide stakeholders and past athletes value as the most important and feasible attrition factors to address to retain talented athletes., Design: Mixed-methods., Methods: Concept mapping was used for qualitative data collection and quantitative data analysis. Sixty-one participants including: (i) past athletes from an Australian state sporting institute; (ii) their families; and (iii) internal and external stakeholders to a HPSS who supported past athletes., Results: Participants brainstormed 83 unique statements (i.e. attrition factors) that were mapped into 13 clusters of attrition factors following multidimensional scaling and hierarchical cluster analysis performed on the participants sorting data: 'abuse and mismanagement of health'; 'athlete health'; 'limited support/resourcing'; 'coaching'; 'inconsistent processes'; 'financial and career support'; 'pathway structure'; 'organisational dynamics'; 'competitive stress'; 'performance potential'; 'challenges with selection and transition'; 'psychological state'; and 'competing non-sport priorities'. 'Abuse and mismanagement of health' had the highest mean importance (3.76 out of 5) and feasibility (3.31) rating. The 13 clusters were further grouped into four overarching domains: 'sport system policy, structure and processes'; 'pathway structure, transition and support'; 'individual athlete health and capability'; and 'whole-of-life demands and priorities'. The domain 'sport system policy, structure and processes' contained the most important and feasible clusters., Conclusions: Macro (system-level) and micro (intrapersonal and interpersonal) level athlete attrition factors should be considered together. Athlete health was considered the most important athlete retention issue to address., (Copyright © 2022. Published by Elsevier Ltd.)

Emergency services personnel are a high stress occupation, being frequently confronted with highly consequential stressors and expected to perform: without fault; under high pressure; and in unpredictable circumstances. Research often invokes similarities between the experiences of emergency services personnel and elite athletes, opening up the possibility of transferring learnings between these contexts. Both roles involve genuine risks to emotional wellbeing because their occupations involve significant stress. Similarly, both roles face obstacles and injury, and their "success" is dependent on high-quality execution of their skills under pressure. As such, both occupations are required to have resilience and effective coping abilities to ensure psychological well-being. Researchers suggest emotional awareness may be a key variable in the management and maintenance of resilience. This study: (1) explored the experiences of emergency services personnel; (2) characterised connections between emotional awareness and resilience; and (3) reflected on the ways these findings can be extrapolated to elite athletes. We analysed 11 interviews with emergency services personnel. Participants identified resilience as crucial when coping with stress, however, many defined resilience as remaining unaffected by stress rather than, for example, managing and responding to it. Participants defined emotional awareness as understanding their emotions, and they recognised associated benefits for coping, resilience, and burnout. Nevertheless, most participants did not engage in practices to improve their emotional awareness. Barriers, such as maladaptive beliefs and help-seeking stigma, interfered with participants' ability to cultivate emotional awareness, to promote resilience. In contrast, some participants described profound improvements in resilience and coping following the cultivation of emotional awareness. This finding illustrates that systemic change must target the individual, team, and organisation to correct misperceptions about resilience, emotional awareness, and psychological help-seeking. Developing emotional awareness may help emergency services personnel and other high stress occupations like elite athletes process difficult experiences and enhance their resilience, promoting well-being, and career longevity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Jacobs and Keegan.)

Military personnel often perform complex cognitive operations under unique conditions of intense stress. This requirement to perform diverse physical and mental tasks under stress, often with high stakes, has led to recognition of the term 'tactical athlete' for these performers. Impaired cognitive performance as a result of this stress may have serious implications for the success of military operations and the well-being of military service men and women, particularly in combat scenarios. Therefore, understanding the nature of the stress experienced by military personnel and the resilience of cognitive functioning to this stress is of great importance. This review synthesises the current state of the literature regarding cognitive resilience to psychological stress in tactical athletes. The experience of psychological stress in military personnel is considered through the lens of the Transactional Theory of stress, while offering contemporary updates and new insights. Models of the effects of stress on cognitive performance are then reviewed to highlight the complexity of this interaction before considering recent advancements in the preparation of military personnel for the enhancement of cognitive resilience. Several areas for future research are identified throughout the review, emphasising the need for the wider use of self-report measures and mixed methods approaches to better reflect the subjective experience of stress and its impact on the performance of cognitive operations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Flood and Keegan.)

Personnel in many professions must remain "ready" to perform diverse activities. Managing individual and collective capability is a common concern for leadership and decision makers. Typical existing approaches for monitoring readiness involve keeping detailed records of training, health and equipment maintenance, or - less commonly - data from wearable devices that can be difficult to interpret as well as raising privacy concerns. A widely applicable, simple psychometric measure of perceived readiness would be invaluable in generating rapid evaluations of current capability directly from personnel. To develop this measure, we conducted exploratory factor analysis and confirmatory factor analysis with a sample of 770 Australian military personnel. The 32-item Acute Readiness Monitoring Scale (ARMS) demonstrated good model fit, and comprised nine factors: overall readiness; physical readiness; physical fatigue; cognitive readiness; cognitive fatigue; threat-challenge (i.e., emotional/coping) readiness; skills-and-training readiness; group-team readiness, and equipment readiness. Readiness factors were negatively correlated with recent stress, current negative affect and distress, and positively correlated with resilience, wellbeing, current positive affect and a supervisor's rating of solider readiness. The development of the ARMS facilitates a range of new research opportunities: enabling quick, simple and easily interpreted assessment of individual and group readiness., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Keegan, Flood, Niyonsenga, Welvaert, Rattray, Sarkar, Melberzs and Crone.)

To complement and enhance readiness-monitoring capability, the Acute Readiness Monitoring Scale (ARMS) was developed: a widely applicable, simple psychometric measure of perceived readiness. While this tool may have widespread utility in sport and military settings, it remains unknown if the ARMS demonstrates predictive and concurrent validity. Here, we investigated whether the ARMS is: (1) responsive to an acute manipulation of readiness using sleep deprivation, (2) relates to biological markers of readiness [cortisol/heart-rate variability (HRV)], and (3) predicts performance on a cognitive task. Thirty young adults (aged 23 ± 4 years; 18 females) participated. All participants engaged in a 24-h sleep deprivation protocol. Participants completed the ARMS, biological measures of readiness (salivary cortisol, HRV), and cognitive performance measures (psychomotor vigilance task) before, immediately after, 24-, and 48-h post-sleep deprivation. All six of the ARMS subscales changed in response to sleep deprivation: scores on each subscale worsened (indicating reductions in perceived readiness) immediately after sleep deprivation, returning to baseline 24/48 h post. Lower perceived readiness was associated with reduced awakening responses in cortisol and predicted worse cognitive performance (slower reaction time). No relationship was observed between the ARMS and HRV, nor between any biological markers of readiness (cortisol/HRV) and cognitive performance. These data suggest that the ARMS may hold practical utility in detecting, or screening for, the wide range of deleterious effects caused by sleep deprivation; may constitute a quick, cheap, and easily interpreted alternative to biological measures of readiness; and may be used to monitor or mitigate potential underperformance on tasks requiring attention and vigilance., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Summers, Keegan, Flood, Martin, McKune and Rattray.)

Objective: This research aimed to explore the quality-of-life and experiences of people with Achilles tendinopathy., Design: This mixed-methods research used the 8-dimension Assessment of Quality-of-Life (AQoL-8D), focus groups and grounded theory analysis. AQoL-8D scores were compared with population normative scores. In focus groups, participants discussed their experiences with Achilles tendinopathy., Setting: An online survey was completed, followed by focus groups and interviews held at the University of Canberra., Participants: Adults with Achilles tendon pain were eligible to participate in the online survey, which was distributed through email and social media., Results: Complete survey responses were obtained from 92 individuals, and 11 individuals participated in focus groups and interviews. AQoL-8D scores were significantly lower in those with Achilles tendinopathy (79 ± 11 vs 81 ± 13). AQoL-8Ds of mental health, pain, senses, and the physical "super dimension" were also significantly lower. The difference exceeded the AQoL-8D minimum clinically important difference of 6% only for the pain dimension. Themes identified included adapting lifestyles, living with the condition, changes in mental and social well-being, conflict with identity, frustration, and individual experiences., Conclusions: Achilles tendinopathy is associated with a lower quality-of-life score, but on average, the difference does not exceed the minimum clinically important difference. In focus groups, some individuals described profound impacts on their life. This discrepancy likely reflects the variability of the impact across individuals. For some people, the effect is minimal, yet for those who tie their identity and social activities to fitness and physical activity, the effect can be profound.

The aim of this communication is to highlight synergies and opportunities between the fields of education, sport and health and the performing arts for the promotion of physical literacy. First, physical literacy is introduced and then defined according to the definition used in this communication. Secondly, we highlight the gap in physical literacy interventions, in that they do not address learning based on a holistic comprehensive definition of physical literacy. Then we provide examples of interventions that do borrow from the arts, such as circus arts, and show how these approaches explicitly link to the discipline of arts. This is followed by program examples, which approach motor and language development from discipline-specific perspectives. Then we introduce actor training (within the discipline of arts) in terms of how this approach may be useful to our understanding of physical literacy and how to expand the conception of physical literacy to include affective meaning making, and tolerance for ambiguity and discomfort in not-knowing. Finally, we conclude with the next step for the bridging of disciplines in order to further our journey to understand and improve physical literacy.

The green tea amino acid, L-theanine (L-THE) is associated with several health benefits, including improvements in mood, cognition and a reduction of stress and anxiety-like symptoms. This systematic review evaluated the effect of pure L-THE intake, in the form of orally administered nutritional supplements, on stress responses and anxiety levels in human randomised controlled trials. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, 9 peer-reviewed journal articles were identified where L-THE as a supplement was compared to a control. Our findings suggest that supplementation of 200-400 mg/day of L-THE may assist in the reduction of stress and anxiety in people exposed to stressful conditions. Despite this finding, longer-term and larger cohort clinical studies, including those where L-THE is incorporated into the diet regularly, are needed to clinically justify the use of L-THE as a therapeutic agent to reduce stress and anxiety in people exposed to stressful conditions.

The purpose of this three-study paper was to develop and validate the Perceived Social Influence in Sport Scale-2 (PSISS-2) that aimed to resolve the limitations of PSISS-1 in assessing the relative social influence of significant others in youth sport. In Study 1, a pool of 60 items generated from revisiting a qualitative dataset about significant others of young athletes were examined by two expert panel reviews in terms of content validity, clarity, coverage, and age-appropriateness, leading to the development of 16 items of the PSISS-2. In Study 2, multi-group exploratory structural equation model for PSISS-2 was conducted among 904 young athletes, and the results supported a model comprising positive influence (ie, conditional and unconditional positive influence combined), punishment (ie, conditional negative influence), and dysfunction (ie, unconditional negative influence) as three factors. The goodness of fit of the three-factor model was acceptable and invariant across the coach-, father-, mother-, and teammates-versions of PSISS-2. In support of the criterion validity of PSISS-2, the three factors explained substantial variance of young athletes' perceived competence, effort, enjoyment, and trait anxiety in sport. Study 3 examined the relationship between PSISS-2 factors, psychological need support, and controlling behaviors in a subsample of 452 young athletes, and the findings supported the concurrent validity and discriminant validity of the scale. In conclusion, the data are supportive of PSISS-2. The three factors of the scale (ie, positive influence, punishment, and dysfunction) may form a new framework for understanding and comparing the relative role of significant others in youth sport., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Sports performance at the highest level requires a wealth of cognitive functions such as attention, decision making, and working memory to be functioning at optimal levels in stressful and demanding environments. Whilst a substantial research base exists focusing on psychological skills for performance (e.g., imagery) or therapeutic techniques for emotion regulation (e.g., cognitive behavioral therapy), there is a scarcity of research examining whether the enhancement of core cognitive abilities leads to improved performance in sport. Cognitive training is a highly researched method of enhancing cognitive skills through repetitive and targeted exercises. In this article, we outline the potential use of cognitive training (CT) in athlete populations with a view to supporting athletic performance. We propose how such an intervention could be used in the future, drawing on evidence from other fields where this technique is more fruitfully researched, and provide recommendations for both researchers and practitioners working in the field.

Background: The concept of physical literacy has received increased research and international attention recently. Where intervention programs and empirical research are gaining momentum, their operationalizations differ significantly., Objective: The objective of this study was to inform practice in the measure/assessment of physical literacy via a systematic review of research that has assessed physical literacy (up to 14 June, 2017)., Methods: Five databases were searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols guidelines, with 32 published articles meeting the inclusion criteria. English-language, peer-reviewed published papers containing empirical studies of physical literacy were analyzed using inductive thematic analysis., Results: Qualitative methods included: (1) interviews; (2) open-ended questionnaires; (3) reflective diaries; (4) focus groups; (5) participant observations; and (6) visual methods. Quantitative methods included: (1) monitoring devices (e.g., accelerometers); (2) observations (e.g., of physical activity or motor proficiency); (3) psychometrics (e.g., enjoyment, self-perceptions); (4) performance measures (e.g., exergaming, objective times/distances); (5) anthropometric measurements; and (6) one compound measure. Of the measures that made an explicit distinction: 22 (61%) examined the physical domain, eight (22%) the affective domain; five (14%) the cognitive domain; and one (3%) combined three domains (physical, affective, and cognitive) of physical literacy. Researchers tended to declare their philosophical standpoint significantly more in qualitative research compared with quantitative research., Conclusions: Current research adopts diverse often incompatible methodologies in measuring/assessing physical literacy. Our analysis revealed that by adopting simplistic and linear methods, physical literacy cannot be measured/assessed in a traditional/conventional sense. Therefore, we recommend that researchers are more creative in developing integrated philosophically aligned approaches to measuring/assessing physical literacy. Future research should consider the most recent developments in the field of physical literacy for policy formation.

Money has frequently been used as an extrinsic motivator since it is assumed that humans are willing to invest more effort for financial reward. However, the influence of a monetary reward on pacing and performance in trained athletes is not well-understood. Therefore, the aim of this study was to analyse the influence of a monetary reward in well-trained cyclists on their pacing and performance during short and long cycling time trials (TT). Twentythree cyclists (6 ♀, 17 ♂) completed 4 self-paced time trials (TTs, 2 short: 4 km and 6 min; 2 long: 20 km and 30 min); in a randomized order. Participants were separated into parallel, non-randomized "rewarded" and "non-rewarded" groups. Cyclists in the rewarded group received a monetary reward based on highest mean power output across all TTs. Cyclists in the non-rewarded group did not receive a monetary reward. Overall performance was not significantly different between groups in short or long TTs ( p > 0.48). Power output showed moderatly lower effect sizes at comencement of the short TTs ( P meandiff = 36.6 W; d > 0.44) and the 20 km TT ( P meandiff = 22.6 W; d = 0.44) in the rewarded group. No difference was observed in pacing during the 30 min TT ( p = 0.95). An external reward seems to have influenced pacing at the commencement of time trials. Participants in the non-rewarded group adopted a typical parabolic shaped pattern, whereas participants in the rewarded group started trials more conservatively. Results raise the possibility that using money as an extrinsic reward may interfere with regulatory processes required for effective pacing.

Background: The ergogenic effects of analgesic substances suggest that pain perception is an important regulator of work-rate during fatiguing exercise. Recent research has shown that endogenous inhibitory responses, which act to attenuate nociceptive input and reduce perceived pain, can be increased following transcranial direct current stimulation of the hand motor cortex. Using high-definition transcranial direct current stimulation (HD-tDCS; 2 mA, 20 min), the current study aimed to examine the effects of elevated pain inhibitory capacity on endurance exercise performance. It was hypothesised that HD-tDCS would enhance the efficiency of the endogenous pain inhibitory response and improve endurance exercise performance., Methods: Twelve healthy males between 18 and 40 years of age ( M  = 24.42 ± 3.85) were recruited for participation. Endogenous pain inhibitory capacity and exercise performance were assessed before and after both active and sham (placebo) stimulation. The conditioned pain modulation protocol was used for the measurement of pain inhibition. Exercise performance assessment consisted of both maximal voluntary contraction (MVC) and submaximal muscular endurance performance trials using isometric contractions of the non-dominant leg extensors., Results: Active HD-tDCS (pre-tDCS, -.32 ± 1.33 kg; post-tDCS, -1.23 ± 1.21 kg) significantly increased pain inhibitory responses relative to the effects of sham HD-tDCS (pre-tDCS, -.91 ± .92 kg; post-tDCS, -.26 ± .92 kg; p  = .046). Irrespective of condition, peak MVC force and muscular endurance was reduced from pre- to post-stimulation. HD-tDCS did not significantly influence this reduction in maximal force (active: pre-tDCS, 264.89 ± 66.87 Nm; post-tDCS, 236.33 ± 66.51 Nm; sham: pre-tDCS, 249.25 ± 88.56 Nm; post-tDCS, 239.63 ± 67.53 Nm) or muscular endurance (active: pre-tDCS, 104.65 ± 42.36 s; post-tDCS, 93.07 ± 33.73 s; sham: pre-tDCS, 123.42 ± 72.48 s; post-tDCS, 100.27 ± 44.25 s)., Discussion: Despite increasing pain inhibitory capacity relative to sham stimulation, active HD-tDCS did not significantly elevate maximal force production or muscular endurance. These findings question the role of endogenous pain inhibitory networks in the regulation of exercise performance., Competing Interests: The authors declare there are no competing interests.

Background: The concept of physical literacy has stimulated increased research attention in recent years-being deployed in physical education, sport participation, and the promotion of physical activity. Independent research groups currently operationalize the construct differently., Objective: The purpose of this systematic review was to conduct a systematic review of the physical literacy construct, as reflected in contemporary research literature., Methods: Five databases were searched using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for systematic reviews. Inclusion criteria were English language, peer reviewed, published by March 2016, and seeking to conceptualize physical literacy. Articles that met these criteria were analyzed in relation to three core areas: properties/attributes, philosophical foundations and theoretical associations with other constructs. A total of 50 published articles met the inclusion criteria and were analyzed qualitatively using inductive thematic analysis., Results: The thematic analysis addressed the three core areas. Under definitions, core attributes that define physical literacy were identified, as well as areas of conflict between different approaches currently being adopted. One relatively clear philosophical approach was prominent in approximately half of the papers, based on a monist/holistic ontology and phenomenological epistemology. Finally, the analysis identified a number of theoretical associations, including health, physical activity and academic performance., Conclusions: Current literature contains different representations of the physical literacy construct. The costs and benefits of adopting an exclusive approach versus pluralism are considered. Recommendations for both researchers and practitioners focus on identifying and clearly articulating the definitions, philosophical assumptions and expected outcomes prior to evaluating the effectiveness of this emerging concept., Competing Interests: Compliance with Ethical Standards Funding No sources of funding were used to assist in the preparation of this article. Conflict of interest Lowri C. Edwards, Anna S. Bryant, Richard J. Keegan, Kevin Morgan and Anwen M. Jones declare that they have no conflicts of interest that are relevant to the content of this review.

Aims: To determine the risk of withdrawal from training of Australian and New Zealand general surgical registrars, and to investigate factors associated with increased risk., Methods: An invitation to participate in an online survey was distributed to all Australian and New Zealand general surgical registrars by the Royal Australasian College of Surgeons., Results: 142 of 550 (26%) participants completed the survey. Overall, 54% (n=77) of respondents had considered leaving surgical training. Female trainees were significantly more likely to consider leaving training compared to males (65% vs 47%, p=0.036, OR 2.1). Respondents who studied in Australia or New Zealand, compared to overseas, were also significantly more likely to consider leaving surgical training (59% vs 35%, p=0.023, OR 2.7). The most common reason for potential withdrawal was poor lifestyle and quality of life during surgical training. Trainees at risk of withdrawal felt less supported, less satisfied with teaching and less confident in their operative skills., Conclusion: Female and locally-trained general surgical registrars are at a higher risk of withdrawal during their training programme for a number of reasons. At risk trainees are also less satisfied with their programme.

Mushrooms exposed to sunlight or UV radiation are an excellent source of dietary vitamin D2 because they contain high concentrations of the vitamin D precursor, provitamin D2. When mushrooms are exposed to UV radiation, provitamin D2 is converted to previtamin D2. Once formed, previtamin D2 rapidly isomerizes to vitamin D2 in a similar manner that previtamin D3 isomerizes to vitamin D3 in human skin. Continued exposure of mushrooms to UV radiation results in the production of lumisterol2 and tachysterol2. It was observed that the concentration of lumisterol2 remained constant in white button mushrooms for up to 24 h after being produced. However, in the same mushroom tachysterol2 concentrations rapidly declined and were undetectable after 24 h. Shiitake mushrooms not only produce vitamin D2 but also produce vitamin D3 and vitamin D4. A study of the bioavailability of vitamin D2 in mushrooms compared with the bioavailability of vitamin D2 or vitamin D3 in a supplement revealed that ingestion of 2000 IUs of vitamin D2 in mushrooms is as effective as ingesting 2000 IUs of vitamin D2 or vitamin D3 in a supplement in raising and maintaining blood levels of 25-hydroxyvitamin D which is a marker for a person's vitamin D status. Therefore, mushrooms are a rich source of vitamin D2 that when consumed can increase and maintain blood levels of 25-hydroxyvitamin D in a healthy range. Ingestion of mushrooms may also provide the consumer with a source of vitamin D3 and vitamin D4.