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Aim: To report the experience of chronic pain participants after a well-formulated ketogenic diet (WFKD) or whole-food diet (WFD). The quantitative outcomes for this trial have been published separately (clinical trial registration number ACTRN12620000946910). Patients & methods: The experience of 24 participants was evaluated after 12 and 24 weeks of dietary intervention using survey responses and open questions. Results & conclusion: Retention rates for the WFKD and WFD groups were 93 and 89%, respectively. Average adherence to the WFKD was 82% and to the WFD was 87%. The WFKD enjoyment was rated at 66 and 81% for the WFD group. The ease of adhering to the diet varied more widely for the WFKD group. Barriers included knowledge integration, time management, navigating social food environments and emotional attachment to eliminated foods. Facilitators included structured support and coaching, and comprehensive learning materials. The WFKD was shown to be a feasible and effective treatment option for chronic pain.

Bioenergetic failure caused by impaired utilisation of glucose and fatty acids contributes to organ dysfunction across multiple tissues in critical illness. Ketone bodies may form an alternative substrate source, but the feasibility and safety of inducing a ketogenic state in physiologically unstable patients is not known.Twenty-nine mechanically ventilated adults with multi-organ failure were randomised into a two-centre safety and feasibility trial of ketogenic versus standard enteral feeding. Ketogenic feeding was feasible, safe, well tolerated and resulted in ketosis. Patients receiving ketogenic feeding had fewer hypoglycaemic events (0% vs. 1.58%), required less exogenous insulin (0.0 IU (IQR 0-16) vs.78 IU (IQR 0-412) but had slightly more daily episodes of diarrhoea (53.5% vs. 42.9%) over the trial period. Untargeted metabophenotyping revealed altered Cahill cycle flux and bioenergetic states, suggesting an advantageous metabolic profile. Ketogenic feeding is feasible and may be a novel intervention for addressing bioenergetic failure in critically ill patients.Clinical Trials.govregistration:NCT04101071; 19.09.2019.Take-home MessageCritical illness leads to altered metabolic states and bioenergetic failure caused by impaired utilisation of glucose, fatty acids and amino acids. This contributes to organ dysfunction across multiple tissues. Ketones may provide a safe and acceptable alternative metabolic fuel enabling energy production and maintaining tissue homeostasis.TweetKetogenic enteral feeding in early critical illness is feasible, safe and may decrease insulin requirements.

Background It is known that exercise is beneficial to people with substance use disorder, however little evidence exists regarding their exercise capacity. This pilot study investigates the exercise capacity of patients with substance use disorder and effects of an acute bout of exercise on affect. Methods Twenty-nine participants admitted to a withdrawal management facility were recruited to complete a health and exercise assessment (18 females, 11 males; 41 ± 11 years old). Mood was measured before and after exercise assessments using the subjective experience to exercise scale. Data was grouped by sex, and descriptive analyses were performed against age-matched normative data. Within group, before and after subjective experience to exercise scale measures were analyzed using 2-way ANOVA with sex as a between subject factor. Results Participants ranged from having 2 to 6 modifiable cardiovascular risk factors. Participants performed below average compared to age-matched and sex-matched normative data for the 6-minute walk test (females: 539 ± 54 m, males: 606 ± 89 m); and push-up test (females: 22% good, males: 36% good). Of the 29 participants, 29% failed to achieve the average range for sex-matched norms in the sit-to-stand test. However, all participants achieved above average for curl-ups, and 72% achieved an average or above score in the step-up test. Exercise significantly increased wellbeing (P < 0.001, effect size = 1.12) and decreased psychological distress (P = 0.045, effect size = 1.03) and fatigue (P < 0.001, effect size = 1.32). Conclusion Exercise is both feasible and beneficial in a withdrawal management setting. Capacity to perform exercise was generally poor with high individual variance. Design of future interventions will need tailored prescription for patients in this population.

Introduction: Quality of life and affective outcomes offer a perspective of the burden of disease experienced by people with substance use disorder. This can be considered an alternative measure of substance use disorder severity. This review aims to evaluate the impact of exercise as a novel intervention on quality of life and affect in substance use disorder. Method: Medline, CINAHL, Amed, Web of Science core collections, Embase, PsychINFO and SportDISCUS databases were searched from inception to August 2021 for studies that assessed the impact of exercise on mood, depression, anxiety and quality of life outcomes in substance use disorder. Exercise interventions of any duration were included. Results: Forty-two studies met the inclusion criteria. Quality of life scores improved with larger effects seen in studies with two or more sessions per week. Depression and anxiety scores decreased, with 19 of the 25 data sets reporting a reduction in depression (effect size 0.2–1.86) and 13 of the 17 data sets reporting a reduction in anxiety (effect sizes 0.2–1.42). Mood improved in six of the seven data sets reviewed with effect sizes ranging from 0.34 to 1.13. Discussion: Included studies had numerous methodological flaws therefore results need to be interpreted with caution. Further research needs to be completed with more rigorous methodologies to support these results. Conclusions: Results indicate promising responses to exercise as a novel intervention for quality of life and mood in substance use disorder, however further research of high methodological quality is needed to confirm.

Consumption of sugar-sweetened beverages (SSBs) during pregnancy has been associated with childhood obesity. Research in which rodent dams have been given high-fat/high-sugar diets has consistently found metabolic alterations in their offspring. However, what remains unclear is the potential impact on the developing fetus of giving sugar in isolation at concentrations similar to SSBs to the mothers. Therefore, we conducted a systematic review and meta-analysis (Protocol No: 127115 on Prospero) to identify potential relationships between maternal sucrose consumption and metabolic outcomes in offspring of rodent (rat or mouse) models. We analysed studies that provided rodent mothers dams with access to sucrose solutions (8–20% w/v) prior to conception, during pregnancy and/or lactation and that reported offspring outcomes of body weight (BW), body composition and glycaemic control. Following a systematic search of four databases (PubMed, EMBASE, Web of Science and Scopus) performed on 15 January 2019, maternal and offspring data from 15 papers were identified for inclusion. Only rat studies were identified. Meta-analyses were performed on standardised mean differences for maternal and offspring BW and fasting glucose levels, with subgroup analyses of strain, sucrose concentration, exposure period and sex of offspring. A bias towards the inclusion of only data from male offspring was identified and this limited interpretation of potential sexually dimorphic outcomes. Maternal sucrose exposure was associated with an increased risk of obesity and poor glucose disposal in adult and aged offspring.

Background Acute skeletal muscle wasting in critical illness is associated with excess morbidity and mortality. Continuous feeding may suppress muscle protein synthesis as a result of the muscle-full effect, unlike intermittent feeding, which may ameliorate it. Research Question Does intermittent enteral feed decrease muscle wasting compared with continuous feed in critically ill patients? Study Design and Methods In a phase 2 interventional single-blinded randomized controlled trial, 121 mechanically ventilated adult patients with multiorgan failure were recruited following prospective informed consultee assent. They were randomized to the intervention group (intermittent enteral feeding from six 4-hourly feeds per 24 h, n = 62) or control group (standard continuous enteral feeding, n = 59). The primary outcome was 10-day loss of rectus femoris muscle cross-sectional area determined by ultrasound. Secondary outcomes included nutritional target achievements, plasma amino acid concentrations, glycemic control, and physical function milestones. Results Muscle loss was similar between arms (–1.1% [95% CI, –6.1% to –4.0%]; P = .676). More intermittently fed patients received 80% or more of target protein (OR, 1.52 [1.16-1.99]; P Interpretation Intermittent feeding in early critical illness is not shown to preserve muscle mass in this trial despite resulting in a greater achievement of nutritional targets than continuous feeding. However, it is feasible and safe. Trial Registry ClinicalTrials.gov; No.: NCT02358512; URL: www.clinicaltrials.gov

Aim: To explore the reported diet of Australians with chronic pain and their perceived role of food within their pain experience. Methods: A cross-sectional study of 50 participants reporting chronic pain was undertaken using pain and nutritional questionnaires as well as anthropometric measures. Results: Participants rated their diet between ‘good’ and ‘excellent' (76%) and one that promoted well-being (62%), however 74% were overweight or obese (average BMI 30) with multiple co-morbidities. There was no correlation between measures of dietary adherence and knowledge with reported pain. Conclusion: Participants generally reported their diets to be good, however, this was not reflected in their habitual diet. There was a low perceived role of food altering pain perception.

Background: Clinical placements and assessment are an essential part of education to become a health professional. However, quality assessment in a clinical environment is challenging without a clear representation of what constitutes competence. The aim of this study was to establish core clinical learning competencies for Australian exercise physiology students. Methods: This study used a mixed-methods, multiphase approach. The competencies were developed following electronic surveys and focus groups, with additional refinement provided by the project team. Preliminary validation was conducted via electronic survey where (i) participants rated the importance of each unit of competency for entry-level practice, and (ii) participants who had recently graduated (n = 23) rated the extent to which they perceived they were competent in each unit. Results: The competencies are described as 19 elements organized into 6 units. The units are (i) communication, (ii) professionalism, (iii) assessment and interpretation, (iv) planning and delivery of an exercise and/or physical activity intervention, (v) lifestyle modification, and (vi) risk management. Of 126 survey participants, the majority (93%–98%) considered each unit as being important for entry-level practice. The majority (78%–95%) of recent graduates considered themselves competent in each unit, suggesting the competencies are articulated around the level of a new practitioner. Conclusion: The core clinical learning competencies resulted from an extensive, iterative process involving those with expertise in the area. The competencies have a range of applications, including informing the development of a student placement assessment tool for use in a clinical placement environment.

Dietary restriction of carbohydrate has been demonstrated to be beneficial for nervous system dysfunction in animal models and may be beneficial for human chronic pain. The purpose of this review is to assess the impact of a low-carbohydrate/ketogenic diet on the adult nervous system function and inflammatory biomarkers to inform nutritional research for chronic pain. An electronic database search was carried out in May 2021. Publications were screened for prospective research with dietary carbohydrate intake n = 394, sport/performance n = 51, cancer n = 33, general n = 30, neurological with non-neuro outcomes n = 12, or gastrointestinal n = 4). The second screen identified sixty-three studies reporting on inflammatory biomarkers, with 71% reporting a reduction in inflammation. The overall results suggest a favourable outcome on the nervous system and inflammatory biomarkers from a reduction in dietary carbohydrates. Both nervous system sensitisation and inflammation occur in chronic pain, and the results from this review indicate it may be improved by low-carbohydrate nutritional therapy. More clinical trials within this population are required to build on the few human trials that have been done.

Background Measurement of serum neuron-specific enolase (NSE) for neuro-prognostication post out-of-hospital cardiac arrest (OHCA) is recommended by international guidelines. There is, however, a lack of consensus regarding the cut-offs and time points to use. In addition, NSE is particularly susceptible to haemolysis interference. This study aimed to define the optimum NSE testing strategy to support the intensive care unit (ICU). Methods Patients admitted to ICU post-OHCA over 16 months had NSE measured. The outcome was survival to ICU discharge. NSE at 0 h, 24 h, 48 h, 72 h and change in NSE (ΔNSE) were assessed for prognostic accuracy using receiver operator characteristic curve analysis. The magnitude of haemolysis interference was quantified by spiking haemolysate into paired serum. Results There is a consistent linear increase in NSE with increasing haemolysis, independent of baseline NSE concentration. A haemolysis index acceptance threshold was defined as 20. There were 142 patients, and 82 survived to ICU discharge. The NSE parameter with best predictive performance was ΔNSE at 48 h, which had an area under the receiver operator characteristic curve of 0.91. A cut-off of >0 μg/L at this time point had sensitivity of 80% and specificity of 97% for predicting death on ICU. When patients who died of non-neurological causes were removed, the sensitivity increased to 91%. Conclusions Application of a stringent haemolysis interference threshold and measurement of NSE at two time points enabled us to achieve excellent discrimination. Increasing NSE over the first 48 h, suggestive of an ongoing reperfusion injury to the brain, is a strong predictor of poor outcome.

To identify core diet and delivery components of low-carbohydrate (CHO) diets that have demonstrated efficacy for type 2 diabetes (T2D) management.MEDLINE, Pre-MEDLINE, EMBASE, CINAHL and the Cochrane Library of Controlled Trials databases were systematically searched from inception until August 18, 2018. Primary intervention studies of low-CHO diets (≤130 g/d or 26% total energy intake [TEI]) were included. Content analysis was performed on the low-CHO diet protocols classified as safe and effective for T2D management.A total of 41 studies published between 1963 and 2018 were included, of which 40 were classified as safe and effective for inclusion in the primary analysis. Thirteen studies (13/40) were on very-low-CHO diets (50 g/d), 14/40 included low-CHO diets (≤130 g/d or 26% TEI), and 13/40 were adapted according to participant progress. Thirty-one studies reported a total energy prescription, of which 18/31 encouraged ad libitum intakes. Twenty studies reported a prescribed dietary fat amount, of which 18/20 were unrestricted or high-fat (35% TEI). Twenty-six studies reported a prescribed dietary protein amount, of which 22 were unrestricted or were high-protein (25% TEI). The types of dietary CHO, fat and protein recommended were predominantly whole foods. Common delivery methods reported were dietician and/or physician involvement, moderate to high frequency of contact (≥1 session/month) and use of participant self-monitoring.Multiple approaches for developing and delivering a low-CHO diet intervention for T2D management are safe and effective. A comprehensive set of core dietary components to consider in the formulation of low-CHO diet protocols were identified for use in clinical practice and to inform evidence-based guidelines for T2D management.

Background: Opioid use disorder has the lowest quality of life (QOL) and highest disease burden of all substance use disorders (SUD). While opioid treatment does lead to initial improvements in QOL it remains below that of the general population. The integration of exercise programs as an adjunct therapy for SUD is gaining popularity. Previous reviews have indicated that exercise offers significant benefits for QOL, however the evidence in an opioid treatment population is lacking. This study will investigate the impact of a 12-week exercise intervention on QOL and mood in a residential opioid treatment rehabilitation program.Methods: This is a 12-week single arm intervention with a natural history control. Participants will complete a baseline screening assessing QOL, mood and exercise habits and those who meet criteria for exercise participation will complete an exercise assessment. The exercise program will be delivered twice per week as part of the group therapy program. Exercise sessions will run for approximately 40 minutes and be at an intensity selected by each of the participants.Conclusions: A recent review indicated that two sessions of exercise for a minimum of 12 weeks leads to an improvement in QOL in general SUD, however, to date minimal studies have been completed in people receiving opioid agonist treatment. Hence, this will be the first study to our knowledge, assessing the role of exercise as an adjunct treatment for QOL in this population.Trial Registration: This trial has been registered with the Australian New Zealand clinical trials registry ACTRN12622000213741.

Background A low-carbohydrate ketogenic diet has been reported to improve chronic pain by reducing inflammation, oxidative stress, and sensitivity within the nervous system. The main aim of this trial is to evaluate the effects of a ketogenic diet on reported pain, blood biomarkers and quality of life in patients with chronic pain. Methods Participants with chronic musculoskeletal pain were recruited for a 12-week diet intervention that commenced with a 3-week run-in diet removing ultra-processed foods, followed by randomization to either a whole-food/well-formulated ketogenic diet (WFKD) or to continue with the minimally processed whole-food diet (WFD). Outcome measures included: average pain (visual analogue scale VAS), blood biomarkers, anthropometrics, adherence, depression, anxiety, sleep, ketones, quality of life, diet satisfaction, and macronutrient intake. Results Average weekly pain improved for both groups. WFKD group VAS reduced by 17.9 ± 5.2 mm (P = .004) and the WFD group VAS reduced 11.0 ± 9.0 mm (P = .006). Both groups also reported improved quality of life (WFKD = 11.5 ± 2.8%, P = .001 and WFD = 11.0 ± 3.5%, P = .014). The WFKD group also demonstrated significant improvements in pain interference (P = 0.013), weight (P Conclusions The implementation of a whole-food diet that restricts ultra-processed foods is a valid pain management tool; however, a low-carbohydrate ketogenic diets may have potentially greater pain reduction, weight loss and mood improvements.

Objectives:Ketogenic diets have reported efficacy for neurological dysfunctions; however, there are limited published human clinical trials elucidating the mechanisms by which nutritional ketosis produces therapeutic effects. The purpose of this present study was to investigate animal models that report variations in nervous system function by changing from a standard animal diet to a ketogenic diet, synthesise these into broad themes, and compare these with mechanisms reported as targets in pain neuroscience to inform human chronic pain trials.Methods:An electronic search of seven databases was conducted in July 2020. Two independent reviewers screened studies for eligibility, and descriptive outcomes relating to nervous system function were extracted for a thematic analysis, then synthesised into broad themes.Results:In total, 170 studies from eighteen different disease models were identified and grouped into fourteen broad themes: alterations in cellular energetics and metabolism, biochemical, cortical excitability, epigenetic regulation, mitochondrial function, neuroinflammation, neuroplasticity, neuroprotection, neurotransmitter function, nociception, redox balance, signalling pathways, synaptic transmission and vascular supply.Discussion:The mechanisms presented centred around the reduction of inflammation and oxidative stress as well as a reduction in nervous system excitability. Given the multiple potential mechanisms presented, it is likely that many of these are involved synergistically and undergo adaptive processes within the human body, and controlled animal models that limit the investigation to a particular pathway in isolation may reach differing conclusions. Attention is required when translating this information to human chronic pain populations owing to the limitations outlined from the animal research.

In parallel with growing consumer interest in reducing sugar intake, manufacturers have increased availability of food and beverage products containing nonnutritive sweeteners (NNSs). However, emerging evidence indicates that specific NNS types have differential effects on cardiometabolic health.This study examined overall changes in the presence of NNSs, sugar alcohols, and free sugars in the Australian food supply and the use of specific NNS types.Data for 21,051 products in 2015 and 21,366 products in 2019 were extracted from The George Institute's FoodSwitch database.The proportion of products containing NNSs, sugar alcohols, free sugars, and a combination of these, as well as proportion of products containing specific NNS types.Changes between 2015 and 2019 were examined using Pearson χBetween 2015 and 2019, there was a significant increase in the proportion of food and beverage products containing NNSs (from 3.8% to 4.3%; P.001) and a significant decrease in products containing free sugars (from 62.7% to 59.9%; P.001),) driven primarily by nondairy beverages. There were changes in the use of specific NNS types between 2015 and 2019, with a large increase in the use of steviol glycosides (from 33.7% to 50.2%) and a large decrease in the use of sucralose (from 42.4% to 30.5%), aspartame (from 21.0% to 14.4%), and acesulfame K (from 57.4% to 27.7%) (P.05 for all).These findings on the use of different NNS, sugar alcohol, and free sugar ingredients and combinations provide important research insights and will be useful in informing government policies that address sugars and other sweeteners in Australian foods.

Reducing consumption of sugar-sweetened beverages (SSBs) has been encouraged due to its strong association with obesity. In parallel, consumption of “diet” or non-nutritive sweetened (NNS) beverages has significantly increased. This has led to burgeoning numbers of animal studies investigating metabolic consequences of NNS beverage consumption. However, most animal study designs do not reflect the way humans consume NNS drinks, thus reducing translational capacity. The present experiment aimed to find an ecologically valid model of NNS consumption and evidence of metabolic recovery following a switch from sucrose to NNS in female and male Sprague Dawley rats. The main behavioural outcome was consumption of commercially available NNS beverages during preference and acceptance testing, with changes to consumption following chronic sucrose consumption as a secondary outcome. The main metabolic outcome was retroperitoneal fat pad mass at culling, with body weight gain and fasting blood glucose levels (FBGLs) as secondary outcomes. In a two-phase experiment, behavioural tests were performed before and after 4 weeks of ad libitum access to 10% w/v sucrose. During Phase 2, the rats were given ad libitum access to assigned commercial NNS drinks for a further 4 weeks, with controls provided access to water only. FBGLs were measured at the end of Phases 1 and 2. Female and male rats accepted commercially available NNS beverages, although the volumes consumed varied considerably. Following the switch from sucrose to NNS (containing no sucrose), no group difference was observed in retroperitoneal fat mass, body weight change or FBGLs, suggesting both sexes exhibited limited metabolic recovery. These findings demonstrate that an ecologically valid model for NNS consumption can be developed for some commercially available NNS beverages to further enhance translational capacity.

Background The standard Western diet is high in processed hyperpalatable foods that displace nutrient-dense whole foods, leading to inflammation and oxidative stress. There is limited research on how these adverse metabolic drivers may be associated with maladaptive neuroplasticity seen in chronic pain and whether this could be attenuated by a targeted nutritional approach. The aim of this study was to review the evidence for whole-food dietary interventions in chronic pain management. Method A structured search of eight databases was performed up to December 2019. Two independent reviewers screened studies and evaluated risk of bias by using the National Institutes of Health assessment tool for controlled or pre–post studies and the Joanna Briggs checklist for case reports. A meta-analysis was performed in Review Manager. Results Forty-three studies reporting on 48 chronic pain groups receiving a whole-food dietary intervention were identified. These included elimination protocols (n = 11), vegetarian/vegan diets (n = 11), single-food changes (n = 11), calorie/macronutrient restriction (n = 8), an omega-3 focus (n = 5), and Mediterranean diets (n = 2). A visual analog scale was the most commonly reported pain outcome measure, with 17 groups reporting a clinically objective improvement (a two-point or 33% reduction on the visual analog scale). Twenty-seven studies reported significant improvement on secondary metabolic measures. Twenty-five groups were included in a meta-analysis that showed a significant finding for the effect of diet on pain reduction when grouped by diet type or chronic pain type. Conclusion There is an overall positive effect of whole-food diets on pain, with no single diet standing out in effectiveness. This suggests that commonalities among approaches (e.g., diet quality, nutrient density, weight loss) may all be involved in modulating pain physiology. Further research linking how diet can modulate physiology related to pain (such as inflammation, oxidative stress, and nervous system excitability) is required.

Sleep disturbance is a common symptom encountered by cannabis-dependent individuals abstaining from cannabis use. In the present study, we investigated the effect of daily aerobic cycling exercise versus control stretching on sleep quality during inpatient cannabis withdrawal in treatment-seeking dependent cannabis users. The protocol incorporated three consecutive phases: a 4-Day (4-Night) (at-home) 'Baseline' phase, a 6-Day (5-Night) 'Treatment' phase (within a 7-Day inpatient hospital stay) and a 3-Day (4-Night) (at-home) 'Post-Treatment' phase. Participants performed 35 min of monitored activity per day during the Treatment phase. The intervention group (n = 19) cycled at ~60% aerobic capacity (VO2max ), while the control group (n = 12) performed a stretching routine. Objective sleep quality was measured nightly throughout the study using wrist actigraphy ratings of subjective sleep quality were also recorded during the Treatment phase. There were no group differences in sleep measures during the Baseline phase (all p > .05). Objective sleep onset latency increased from the Baseline to the Treatment phase in the control (stretching) group (p = .042). In contrast, the Cycling group exhibited improvements in sleep duration (p = .008) and sleep efficiency (p = .023) during the Treatment phase compared to the Baseline phase. Cycling also increased sleep duration (p = .005), decreased average wake bout (p = .040) and tended to increase sleep efficiency (p = .051) compared to stretching during the Treatment phase. Subjective sleep quality ratings did not differ between groups (p > .10). These preliminary findings suggest that moderate-intensity aerobic exercise may attenuate the sleep disturbances associated with cannabis withdrawal.

Much of the global increase in sugar intake is attributable to rising consumption of sugar-sweetened beverages (SSBs). Because people compensate poorly for liquid calories, SSB consumption increases total energy intake, raising the risk of harmful metabolic effects in addition to possible effects of sugars per se. Glucose and fructose, the constituent sugars in sucrose, can exert distinct effects on metabolism and also differ in their satiating properties, suggesting that compensation for the calories in these sugars may also vary. In light of claims that the fructose within sucrose is particularly harmful, the present study compared the effects of giving rats access to either a sucrose or an isoenergetic glucose solution. Adult male rats were fed standard chow and water supplemented with 95 ml of 10% glucose (Glucose group; n = 10), 9% sucrose solution (Sucrose group; n = 10) or water only (Control group; n = 10) daily for 7 weeks. Sugar-fed groups had higher total energy intakes than the Control group, but the extent of this incomplete compensation did not vary between Sucrose and Glucose groups. In a short-term compensation test, sugar groups were less sensitive to the effects of a sweet pre-meal, with no differences between the Glucose and Sucrose groups. Relative to water, both sugars reduced insulin sensitivity after 4 weeks on the diets and elevated fat mass at 7 weeks. Results suggest that sucrose and glucose induce comparable metabolic impairments and alter the homeostatic regulation of food intake even under conditions where daily access is capped.

Background Detection of the mild ketosis induced by severely energy-restricted diets may be a clinically useful way to monitor and promote dietary adherence. Mild ketosis is often assessed using urine dipsticks, but accuracy for this purpose has not been tested. Objective To determine the accuracy of urine dipsticks to detect mild ketosis during adherence to a severely energy-restricted diet. Methods Two hundred and sixty three (263) fasting urine and 263 fasting blood samples were taken from 50 women (mean [standard deviation, SD] age 58.0 [4.3] years and body mass index 34.3 [2.4] kg/m2) before and at six time points during or for up to 10 weeks after 16 weeks of severe energy restriction, achieved with a total meal replacement diet. The amount of ketones (acetoacetate) in the urine was classified as '0 (Negative)', '+/- (Trace)', '+ (Weak)' or '++ (Medium)' by urine dipsticks (Ketostix, Bayer). The concentration of ketones (β-hydroxybutyrate) in the blood was measured with our reference method, a portable ketone monitor (FreeStyle Optium, Abbott). The diagnostic accuracy of the urine dipsticks was assessed from the percent of instances when a person was actually 'in ketosis' (as defined by a blood β-hydroxybutyrate concentration at or above three different thresholds) that were also identified by the urine dipsticks as being from a person in ketosis (the percent 'true positives' or sensitivity), as well as the percent of instances when a person was not in ketosis (as defined by the blood monitor result) was correctly identified as such with the urine dipstick (the percent 'true negatives' or specificity). Thresholds of ≥0.3mM, ≥0.5mM or ≥1.0mM were selected, because mean blood concentrations of β-hydroxybutyrate during ketogenic diets are approximately 0.5mM. Sensitivity and specificity were then used to generate receiver operating characteristic curves, with the area under these curves indicating the ability of the dipsticks to correctly identify people in ketosis (1 = perfect results, 0.5 = random results). Results At threshold blood β-hydroxybutyrate concentrations of ≥0.3mM, ≥0.5mM and ≥1.0mM, the sensitivity of the urine dipsticks was 35%, 52% and 76%; the specificity was 100%, 97% and 78%; and the area under the receiver operating characteristic curves was 0.67, 0.74 and 0.77, respectively. These low levels of sensitivity mean that 65%, 48% or 24% of the instances when a person was in ketosis were not detected by the urine dipsticks. Conclusion Urine dipsticks are not an accurate or clinically useful means of detecting mild ketosis in people undergoing a severely energy-restricted diet and should thus not be recommended in clinical treatment protocols. If monitoring of mild ketosis is indicated (eg, to monitor or help promote adherence to a severely energy-restricted diet), then blood monitors should be used instead.

The artificial sweetener saccharin is available in several forms, including pure saccharin (S) and saccharin sodium salt hydrate (SSSH). Acceptance and preference relative to 2% sucrose for these two forms was assessed using both older female and young male rats. At the higher of two concentrations, ∼0.4%, SSSH was more acceptable and more greatly preferred over 2% sucrose than was a similar concentration of S, whereas little difference between the two forms was detected at the lower concentration, ∼0.1%. These results indicate the importance for researchers of care in choosing and reporting the form of saccharin they use.

Aims Prognostication following out-of-hospital cardiac arrest (OHCA) remains challenging. A multimodal approach is favoured, including consideration of the biomarker neuron-specific enolase (NSE) (Sandroni et al., 2014). Our objective was to investigate the utility of serial NSE measurements and to determine an appropriate cut-off value for prediction of death before hospital discharge using data from our tertiary care center. Methods Retrospective analysis of patients admitted to the critical care unit of a tertiary center critical care unit in the UK following an out-of-hospital cardiac arrest. Measurements and main results We analysed data from 72 patients admitted to our unit over 8 months following out-of-hospital cardiac arrest. Initial NSE level (NSE0) was a poor predictor of outcome. Both NSE level at 48 h post-admission (NSE48) and change in NSE from baseline to 48 h post-admission (ΔNSE) were good predictors of outcome. A cut-off of NSE48 > 69.8 ng/ml gave a specificity of 1.00 and sensitivity of 0.62 for prediction of death before hospital discharge in our patient group, whilst a cut-off of ΔNSE > 31.3 ng/ml gave a specificity of 1.00 and sensitivity of 0.54. In patients who did not survive to hospital discharge, ΔNSE > 9.4 ng/ml was associated with other poor prognostic factors (asytolic/PEA arrest, long downtime before ROSC) and with more rapid deterioration before death. Conclusion Serial measurement of NSE levels (at 0 and 48 h after admission) provides a useful tool to aid prognostication following out-of-hospital cardiac arrest.

High consumption of sugar-sweetened beverages (SSBs) is a risk factor for weight gain and metabolic disease. Whether this risk is reduced by switching to ‘diet’ beverages containing low-calorie sweeteners (LCS) is controversial. Two experiments modeled whether a switch from SSB to LCS beverages produced positive outcomes on behavioral and metabolic measures. Both experiments consisted of a Stage 1, in which adult female rats received unrestricted access to 10% sucrose solution in addition to chow and water for 4 (Experiment 1) or 8 weeks (Experiment 2). In Stage 2 rats were switched to either saccharin (Suc-Sacch) or water (Suc-Water) or remained on 10% sucrose (Suc-Suc) for a further 4 (Experiment 1) or 7 weeks (Experiment 2). Experiment 2 contained a fourth group that was maintained on water throughout (Water-Water). In both experiments energy intake and weight gain in Stage 2 was reduced for Suc-Sacch and Suc-Water groups relative to the Suc-Suc groups and at cull the Suc-Suc groups showed poorer insulin sensitivity and greater g/kg fat than Suc-Water and Suc-Sacch groups. In Experiment 2 short-term place recognition memory was impaired at the end of Stage 1 but recovered to a similar extent in the Suc-Water and Suc-Sacch groups; when the latter groups were compared with the Water-Water group, recovery was found to be essentially complete. A higher saccharin concentration in Experiment 2 than in Experiment 1 increased absolute amounts of saccharin ingested but intake solution volumes remained low. These results show that switching from sucrose to either water or saccharin produces equivalent improvements on both metabolic and cognitive measures.

Consumption of beverages containing around 10% sucrose contributes to worldwide obesity. Studies using rats can increase understanding of the consequences of such consumption. The present experiment aimed to compare male and female rats, first, in terms of cognitive and metabolic impairments produced by excessive intakes of 10% sucrose solution (Stage 1:8 weeks) and, second, with regard to recovery once access to sucrose ceased (Stage 2:4 weeks). All animals had unrestricted access to chow and water throughout. The primary cognitive outcome was performance on a place recognition task. The primary metabolic outcome was retroperitoneal fat pad mass/kg bodyweight at cull, with body weight and glucose tolerance as secondary outcomes. In a 3 × 2 between-subject factorial design the first factor was whether rats had: (1) unlimited access to a 10% sucrose solution and water throughout both stages (Suc-Suc); (2) were switched from sucrose in the 8-week Stage 1 to water only in the 4-week Stage 2 (Suc-Water); or (3) had no access to sucrose in either stage (Water-Water). The second factor was sex. A major metabolic outcome was that of persistent adiposity in both males and females in the Suc-Water condition. As for place recognition, females in the Suc-Suc condition showed greater long-term resistance than males to the impact of excessive sucrose on spatial memory impairment. Overall, few sex differences were found in secondary metabolic outcomes.

Background and aims Cannabis withdrawal is thought to be a major contributor to relapse to cannabis use and is now included in the DSM-5. Aerobic exercise relieves withdrawal symptoms from tobacco and other drugs, but has yet to be tested in cannabis users. Methods A prospective, single blind, parallel-group RCT comparing daily aerobic exercise to a control stretching intervention. Setting A seven-day inpatient hospital admission, with follow-up at 28 days’ post-discharge. Participants The study population will be 80 cannabis dependent adults seeking assistance with cannabis withdrawal. Intervention and comparator Participants in the Intervention group will undergo 35 min of aerobic exercise daily, at 60% of their VO2 Max, on an exercise bicycle. The Control group will participate in a structured non-aerobic daily stretching routine for 35 min daily. Both groups receive treatment as usual in the withdrawal management unit of the hospital. Measurements The primary outcome measure is the severity of cannabis withdrawal symptoms assessed daily using the Cannabis Withdrawal Scale and the Marijuana Cravings Questionnaire – pre and post exercise, across the week. Mechanisms by which exercise may affect cannabis withdrawal will be assessed by analysis of endogenous cannabinoids, and plasma and urine cannabinoid levels. Discussion This is the first RCT of aerobic exercise for cannabis dependence that has a valid control group to aid in interpretation of findings. Should the intervention prove effective, it would give empirical support to an inexpensive and accessible treatment approach for drug withdrawal management.

To estimate the impact of reduced consumption of free sugars in line with World Health Organization recommendations, on sugar farmers globally.Using multiregion input-output analysis, we estimated the proportional impact on production volumes of a 1% reduction in free sugars consumption by the public. We extracted data on sugar production from the Food and Agriculture Organization of the United Nations database for the top 15 sugar-cane- and beet-producing countries globally, and created a custom multiregion input-output database to assess the proportions of production going to human consumption, drawing on household expenditure surveys and national input-output databases (data valid for years 2000-2015). We also considered the impact on production volumes in relation to countries' gross domestic product.A high proportion of current sugar production from these countries goes to human consumption, and would thus be impacted by reduced consumption of sugars. The largest impacts on cane sugar production, and thus on farmers, would likely occur in Brazil, China, India and Thailand and on beet production in Belarus, Germany, Russian Federation and United States of America.A global opportunity exists for public health leadership to bring together the health, economic, environmental and agriculture sectors to collaborate and build capacity for promotion of alternative livelihoods for sugar farmers. Lessons regarding strategy and the importance of political economy factors can be learnt from tobacco control measures. Further research to quantify the impact of reductions in sugars consumption would provide useful insights for designing policies to complement and strengthen efforts to improve diets and health.Estimer l'impact des recommandations émises par l'Organisation mondiale de la Santé en matière de réduction de la consommation de sucres libres sur les producteurs de sucre du monde entier.Nous avons effectué une analyse entrées-sorties multirégionale afin de calculer l'incidence proportionnelle d'une diminution de 1% de la consommation de sucres libres au sein de la population sur les volumes de production. Nous avons puisé dans la base de données de l'Organisation des Nations Unies pour l'alimentation et l'agriculture (FAO) pour obtenir des informations sur les 15 principaux pays producteurs de sucre de canne et de betterave. Nous avons également créé une base de données personnalisée sur les entrées-sorties dans plusieurs régions dont le but était d'évaluer la part destinée à la consommation humaine, en exploitant les renseignements issus des enquêtes sur les dépenses des ménages et des bases de données nationales sur les entrées-sorties (valables pour la période comprise entre 2000 et 2015). Nous avons en outre tenu compte des répercussions qu'exercent les volumes de production sur le produit intérieur brut des pays concernés.Une forte proportion de la production actuelle de sucre originaire de ces pays est dédiée à l'alimentation humaine, et devrait donc subir l'impact d'une baisse de consommation. Les plus touchés par ce phénomène sont le Brésil, la Chine, l'Inde et la Thaïlande pour le sucre de canne tandis que pour le sucre de betterave, il s'agit de l'Allemagne, du Bélarus, des États-Unis d'Amérique et de la Fédération de Russie.Les dirigeants mondiaux de la santé publique ont la possibilité de réunir les secteurs de la santé, de l'économie, de l'environnement et de l'agriculture, d'instaurer une collaboration et de renforcer la capacité de promouvoir des moyens de subsistance alternatifs pour les producteurs de sucre. Divers enseignements concernant la stratégie et l'importance des facteurs politico-économiques peuvent être tirés des mesures de lutte anti-tabac. D'autres recherches visant à quantifier l'impact d'une baisse de la consommation de sucres pourraient apporter un éclairage utile dans l'élaboration de politiques qui accompagneront et accentueront les efforts d'amélioration de la santé et des habitudes alimentaires.Estimar las repercusiones de la reducción del consumo de azúcares libres, de conformidad con las recomendaciones de la Organización Mundial de la Salud, en los productores de azúcar de todo el mundo.Se empleó un análisis multirregional de insumos y productos en el que se estimaron las consecuencias proporcionales en los volúmenes de producción de una reducción del 1 % en el consumo de azúcares libres por parte del público. Se obtuvieron los datos sobre la producción de azúcar de la base de datos de la Organización de las Naciones Unidas para la Alimentación y la Agricultura correspondientes a los 15 principales países productores de caña de azúcar y de remolacha a nivel mundial, y se creó una base de datos de insumos y productos multirregionales personalizada para evaluar las proporciones de la producción que se destinan al consumo humano, a partir de las encuestas de gastos de los hogares y de las bases de datos nacionales de insumos y productos (datos válidos para los años 2000-2015). También se analizaron las consecuencias de los volúmenes de producción del producto interno bruto de los países.La mayor parte de la producción actual de azúcar de estos países se destina al consumo humano y, por lo tanto, se vería afectada por la reducción del consumo de azúcares. Es probable que las consecuencias principales en la producción de azúcar de caña, y por lo tanto en los agricultores, se registren en Brasil, China, India y Tailandia, y en la producción de remolacha en Alemania, Belarús, la Federación Rusa y los Estados Unidos de América.Existe una oportunidad mundial para que los dirigentes de la salud pública reúnan a los sectores de la salud, la economía, el medio ambiente y la agricultura a fin de colaborar y crear condiciones que fomenten los medios de vida alternativos de los productores de azúcar. De las medidas de control del tabaco se pueden aprovechar las lecciones aprendidas sobre la estrategia y la importancia de los factores de economía política. Nuevas investigaciones que cuantifiquen las consecuencias de la reducción del consumo de azúcares aportarían conocimientos útiles para elaborar políticas que complementen y refuercen los esfuerzos por mejorar la alimentación y la salud.الغرض تقدير التأثير الواقع على مزارعي السكر على مستوى العالم بسبب انخفاض استهلاك السكريات الحرة، بما يتماشى مع توصيات منظمة الصحة العالمية. الطريقة باستخدام تحليل المدخلات والمخرجات متعددة مناطق، قمنا بتقدير التأثير النسبي على أحجام الإنتاج بانخفاض بنسبة 1% في استهلاك السكريات الحرة بواسطة العامة. لقد استخرجنا البيانات حول إنتاج السكر من قاعدة البيانات الخاصة بمنظمة الأغذية والزراعة التابعة للأمم المتحدة لأكبر 15 دولة منتجة لقصب السكر والبنجر على مستوى العالم، وأنشأنا قاعدة بيانات مخصصة للمدخلات والمخرجات متعددة المناطق لتقييم نسب الإنتاج التي تُوجه للاستهلاك البشري، بالاعتماد على مسوحات الإنفاق الأسري وقواعد بيانات المدخلات والمخرجات الوطنية (البيانات صالحة للأعوام من 2000 إلى 2015). كما درسنا التأثير على أحجام الإنتاج فيما يتعلق بالناتج المحلي الإجمالي للدول. النتائج تُخصص نسبة عالية من إنتاج السكر الحالي من هذه الدول إلى الاستهلاك البشري، وبالتالي يتأثر هذا الإنتاج بالاستهلاك المنخفض للسكريات. من المحتمل أن تحدث أكبر التأثيرات على إنتاج قصب السكر، وبالتالي على المزارعين، في البرازيل والصين والهند وتايلند، وعلى إنتاج البنجر في بيلاروس وألمانيا والاتحاد الروسي والولايات المتحدة الأمريكية. الاستنتاج توجد فرصة عالمية لقادة الصحة العامة للجمع بين القطاعات الصحية والاقتصادية والبيئية والزراعية، من أجل التعاون وبناء القدرات لتعزيز سبل العيش البديلة لمزارعي السكر. يمكننا من تدابير مكافحة التبغ، أن نتعلم الدروس المتعلقة بالاستراتيجية وأهمية عوامل الاقتصاد السياسي. إن إجراء مزيد من البحوث لتحديد حجم تأثير التخفيضات في استهلاك السكريات، سوف يوفر رؤى مفيدة لتصميم سياسات لتكملة وتعزيز الجهود المبذولة لتحسين النظم الغذائية والصحة.评估依据世界卫生组织的建议减少游离糖摄入对全球糖农的影响。.我们基于多区域投入产出分析，评估公众的游离糖摄入量减少 1% 对产量的正比影响。 我们从美国粮食及农业组织数据库中提取了全球 15 大甘蔗和甜菜生产国的食糖产量数据，并定制创建多区域投入产出数据库，基于家庭支出调查和国家投入产出数据库（2000-2015 年有效数据），评估产量和人类摄入之间的比例。我们还考虑了国家国内生产总值对产量的影响。.目前，这些国家生产的绝大部分食糖均用于人类摄入，因此，食糖产量必将受到糖摄入减少举措的影响。其中对巴西、泰国、印度、中国这些国家的蔗糖产量和农民影响最大，对白俄罗斯、德国、俄罗斯和美国的甜菜产量影响最大。.全球公共卫生领导需召集卫生、经济、环境和农业部门进行合作，为糖农寻求替代生计。可从烟草控制举措中汲取一些经验教训，如战略和政治经济因素的重要性。深入研究，量化糖摄入减少产生的影响，可为制定补充及加强改善饮食和健康的政策提供有益见解。.Оценить влияние снижения потребления свободных сахаров на сахарных плантаторов в глобальном масштабе в соответствии с рекомендациями Всемирной организации здравоохранения.Используя анализ затрат и выхода в нескольких регионах, мы оценили пропорциональное влияние на объемы производства при снижении потребления населением свободных сахаров на 1%. Мы извлекли данные о производстве сахара из базы данных Продовольственной и сельскохозяйственной организации ООН по 15 ведущим странам-производителям сахарного тростника и свеклы в мире и создали настраиваемую межрегиональную базу данных «затраты-выход» для оценки доли производства, идущей на потребление людьми, на основе опросов о расходах домашних хозяйств и национальных баз данных «затраты-выход» (действительные данные за 2000–2015 годы). Мы также рассмотрели влияние на объемы производства относительно показателей валового внутреннего продукта стран.Большая часть текущих произведенных объемов сахара в указанных странах идет на потребление людьми, и таким образом сокращение потребления сахара повлияет на его производство. Наибольшее влияние на производство тростникового сахара и, следовательно, на плантаторов, вероятно, будет иметь место в Бразилии, Индии, Китае и Таиланде, а также влияние будет оказано на производство свеклы в Беларуси, Германии, Российской Федерации и Соединенных Штатах Америки.Для лидеров общественного здравоохранения существует глобальная возможность объединить секторы здравоохранения, экономики, защиты окружающей среды и сельского хозяйства с целью сотрудничества и создания потенциала в вопросах продвижения альтернативных источников средств к существованию для сахарных плантаторов. Уроки, касающиеся стратегии и важности факторов политической экономики, можно извлечь из мер по борьбе против табака. Дальнейшие исследования по количественной оценке влияния сокращения потребления сахара дадут полезную информацию для разработки политик, дополняющих и укрепляющих усилия по улучшению питания и состояния здоровья.

Rats first given 24-h access to 10% sucrose for 4 or 12 days (Stage 1) were then switched to a saccharin solution for a 12-day Stage 2. The initial result of this switch was that these Sucrose groups drank less saccharin than Water groups that had been given only water to drink in Stage 1. This difference was maintained throughout Stage 2 by the females that served in Experiments 1 and 4 and by the males that served in Experiment 3. Experiment 1 also found that access to 10% glucose in Stage 1 produced an essentially identical decrease in subsequent saccharin acceptance as that produced by giving 10% sucrose in Stage 1. The impact on subsequent acceptance of saccharin was also tested in rats given two types of maltodextrin solution. The first type of maltodextrin (Myopure brand) was used with the males in Experiment 2; this failed to find any difference between the Maltodextrin and the Water group. However, when a second type of maltodextrin (SolCarb brand) was given to males in Stage 1 of Experiment 3, the results for this group were similar to those from a group given sucrose in Stage 1. The final experiment confirmed that prior exposure to maltodextrin solutions can reduce saccharin acceptance by female rats. Overall, the results suggest that acceptance of saccharin is sensitive to a contrast effect, in that it is reduced by prior exposure to a solution that is more palatable but not necessarily sweet.

Reproducible science requires transparent reporting. The ARRIVE guidelines were originally developed in 2010 to improve the reporting of animal research. They consist of a checklist of information to include in publications describing in vivo experiments to enable others to scrutinise the work adequately, evaluate its methodological rigour, and reproduce the methods and results. Despite considerable levels of endorsement by funders and journals over the years, adherence to the guidelines has been inconsistent, and the anticipated improvements in the quality of reporting in animal research publications have not been achieved.Here we introduce ARRIVE 2019. The guidelines have been updated and information reorganised to facilitate their use in practice. We used a Delphi exercise to prioritise the items and split the guidelines into two sets, the ARRIVE Essential 10, which constitute the minimum requirement, and the Recommended Set, which describes the research context. This division facilitates improved reporting of animal research by supporting a stepwise approach to implementation. This helps journal editors and reviewers to verify that the most important items are being reported in manuscripts. We have also developed the accompanying Explanation and Elaboration document that serves 1) to explain the rationale behind each item in the guidelines, 2) to clarify key concepts and 3) to provide illustrative examples. We aim through these changes to help ensure that researchers, reviewers and journal editors are better equipped to improve the rigour and transparency of the scientific process and thus reproducibility.

Improving the reproducibility of biomedical research is a major challenge. Transparent and accurate reporting are vital to this process; it allows readers to assess the reliability of the findings, and repeat or build upon the work of other researchers. The NC3Rs developed the ARRIVE guidelines in 2010 to help authors and journals identify the minimum information necessary to report in publications describing in vivo experiments.Despite widespread endorsement by the scientific community, the impact of the ARRIVE guidelines on the transparency of reporting in animal research publications has been limited. We have revised the ARRIVE guidelines to update them and facilitate their use in practice. The revised guidelines are published alongside this paper. This Explanation and Elaboration document was developed as part of the revision. It provides further information about each of the 21 items in ARRIVE 2019, including the rationale and supporting evidence for their inclusion in the guidelines, elaboration of details to report, and examples of good reporting from the published literature.

Background: Type 1 diabetes (T1D) is an autoimmune condition characterised by pancreatic beta cell destruction and absolute insulin deficiency. The varying impact of dietary factors on blood glucose levels is well-known, yet there remains a lack of consensus surrounding the optimal dietary approaches to achieve glycaemic control in T1D. The aim of this research is to assess the efficacy of a low-carbohydrate (LC) diet in adults with T1D. We will set out to determine whether significant differences in T1D management outcomes exist between a LC diet and habitual diets higher in carbohydrate. Our primary hypothesis is that a LC diet will result in improved T1D management compared to habitual diets higher in carbohydrates. Methods: This is a 28-week single arm within-participant intervention study involving a 4-week control period, a 12-week intervention period and a 12-week follow-up. We plan to recruit 20 adults (18-60 years) with T1D (duration ≥6 months) who have suboptimal glycaemic control (HbA1c>7.0%). The primary outcome is haemoglobin A1c (HbA1c) and secondary outcomes include glycaemic variability, frequency of hypoglycaemia, total daily insulin, and quality of life. This LC diet will start at 50 g of digestible carbohydrate per day and then there will be opportunity to increase or decrease within a broader range of 25-75 g/day according to individual blood glucose levels and personal preference. Participants will meet individually with the study dietitian for a total of six fortnightly sessions to receive dietary instruction, strategies, and education. Participants will continue to work with a member of their usual diabetes care team for specific advice regarding insulin management.Conclusions: Current dietary management strategies for T1D appear to be lacking in effect and additional dietary therapies, including LC diets, require urgent consideration. Therefore, an interventional study investigating a patient-led LC dietary approach will be of important clinical relevance for healthcare practitioners and may help to better inform clinical practice guidelines for T1D management.Trial Registration: https://www.anzctr.org.au/ACTRN12621000764831.aspx

Limited research addresses links between obesity and cognitive function in young adults.Objective. To investigate the relationship between obesity and cognitive function in young women.Methods. This cross-sectional study recruited healthy, young (18–35 y) women of normal (NW: BMI = 18.5–24.9 kg·m−2) or obese (OB: BMI ≥ 30.0 kg·m−2) weight. Participants completed a validated, computer-based cognitive testing battery evaluating impulsivity, attention, information processing, memory, and executive function. Questionnaires on depression and physical activity and a fasting blood sample for C-reactive protein and the Omega-3 Index were also collected. Cognition data are presented asz-scores (mean ± SD), and group comparisons were assessed via ANOVA. Potential confounding from questionnaire and blood variables were evaluated using ANCOVA.Results. 299 women (NW:n = 157; OB:n = 142) aged 25.8 ± 5.1 y were enrolled. Cognition scores were within normal range (±1z-score), but OB had lower attention (NW: 0.31 ± 1.38; OB: −0.25 ± 1.39; ES: 0.41, CI: 0.17–0.64;p<0.001) and higher impulsivity (NW: 0.36 ± 1.14; OB: −0.07 ± 1.07; ES: 0.39, CI: 0.15–0.62;p=0.033). Confounder adjustment had minimal impact on results.Conclusion. The OB group had normal but significantly lower performance on attention and were more impulsive compared to NW participants. This may indicate early cognitive decline, but longitudinal research confirming these findings is warranted.

Following previous results indicating that low acceptance of saccharin-sweetened yoghurt was associated with slower weight gain, the aim of this experiment was to determine which of three measures of individual differences would predict subsequent chow consumption, body weight gain, and fat mass. Pre-test measures consisted of amount of running in an activity wheel, amount of 0.1% saccharin solution consumed over 24h, and performance on an elevated plus maze (EPM). Rats were then maintained for three weeks on a diet of standard chow and water. Subsequent post-testing repeated the procedures used in pre-testing. The rats were then culled and fat pads excised and weighed. Pre-testing revealed a negative correlation between saccharin acceptance and activity, while neither measure correlated with anxiety in the EPM. Pre-test saccharin acceptance was positively correlated with subsequent chow consumption, percent weight gain, and g/kg fat mass. Multiple regression analyses including all three pre-test measures confirmed saccharin acceptance as a predictor of chow consumption and, marginally, of fat pad mass, while high anxiety predicted low percent body weight gain.

Objectives There is increasing evidence that physical activity (PA) positively affects cognitive function (CF). Existing research has focussed on this association in children and the elderly, with less research available in young to middle-aged adults who constitute a substantial proportion of the population. Design A systematic review investigating the relationship between habitual PA (≥12 months) and CF in young to middle-aged adults (18–50 years). Methods A search was conducted using AMED, CINAHL, MEDLINE, PsychINFO, AUSPORT MED and SPORTDiscus databases. Eligible studies had to report descriptive statistics for CF and PA levels in healthy participants 18–50 years. Effect sizes (ES) (Hedges g) were calculated where possible. Results The initial search netted 26,988 potentially relevant manuscripts, with four more identified through hand searching. Fourteen were included for review. A range of validated platforms assessed CF across three domains: executive function (12 studies), memory (four studies) and processing speed (seven studies). Habitual PA was assessed via questionnaire/self-report methods ( n =13, 8 validated) or accelerometers ( n =1). In studies of executive function, five found a significant ES in favour of higher PA, ranging from small to large. Although three of four studies in the memory domain reported a significant benefit of higher PA, there was only one significant ES, which favoured low PA. Only one study examining processing speed had a significant ES, favouring higher PA. Conclusions A limited body of evidence supports a positive effect of PA on CF in young to middle-aged adults. Further research into this relationship at this age stage is warranted.

Throwing velocity is an important aspect of fielding in cricket to affect run-outs and reduce the opponent's run-scoring opportunities. Although a relationship between strength and/or power and throwing velocity has been well established in baseball, water polo, and European handball, it has not been adequately explored in cricket. Consequently, this study aimed to determine the relationship between measures of strength and/or power and throwing velocity in cricket players. Seventeen male cricket players (mean ± SD; age, 21.1 ± 1.6 years; height, 1.79 ± 0.06 m; weight, 79.8 ± 6.4 kg) from an elite athlete program were tested for maximal throwing velocity from the stretch position and after a 3-meter shuffle. They were also assessed for strength and power using a range of different measures. Throwing velocity from the stretch position (30.5 ± 2.4 m·s) was significantly related to dominant leg lateral-to-medial jump (LMJ) distance (r = 0.71; p < 0.01), dominant shoulder internal rotation (IR) strength (r = 0.55; p ≤ 0.05), and dominant (r = 0.73; p < 0.01) and nondominant (r = 0.54; p ≤ 0.05) medicine ball rotation (MB Rot) throw velocity and medicine ball chest pass (MB CP) distance (r = 0.67; p < 0.01). A nonsignificant trend was observed for vertical jump (VJ) height (p = 0.06), whereas no significant relationships were observed for nondominant LMJ distance (p = 0.97), nondominant shoulder IR strength (p = 0.80), 1 repetition maximum (RM) squat strength (p = 0.57), 1RM bench press strength (p = 0.90), height (p = 0.33), or weight (p = 0.29). Multiple regression analysis revealed that dominant MB Rot and MB CP explained 66% of the variance. The results were similar for velocity after a shuffle step (31.8 ± 2.1 m·s); however, VJ height reached statistical significance (r = 0.51; p ≤ 0.05). The multiple regression was also similar with MB Rot and MB CP explaining 70% of the variance. The cricketers in this study threw with greater velocity than elite junior and subelite senior cricketers but with lower velocities than elite senior cricketers and collegiate level and professional baseball players. This is the first study to demonstrate a link between strength and/or power and throwing velocity in cricket players and highlight the importance of power development as it relates to throwing velocity. Exercises that more closely simulated the speed (body weight jumps and medicine ball throws) or movement pattern (shoulder IR) of overhead throwing were greater predictors of throwing velocity. Strength and conditioning staff should assess and develop power to enhance throwing performance in cricket players. Exercises with greater movement and speed specificity to throwing should be used in preference over exercises that are slower and have less movement specificity to the throwing motion. Cricket players should engage in power training to bridge the gap in performance between them and baseball players.

Background: cancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS. Methods: we conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for previous surgical cancellations were recorded. Using multilevel logistic regression, we identified patient- and hospital-level factors associated with cancellation due to inadequate bed capacity. Results: we analysed data from 14 936 patients undergoing planned surgery. A total of 1499 patients (10.0%) reported previous cancellation for the same procedure; contemporaneous hospital census data indicated that 13.9% patients attending inpatient operations were cancelled on the day of surgery. Non-clinical reasons, predominantly inadequate bed capacity, accounted for a large proportion of previous cancellations. Independent risk factors for cancellation due to inadequate bed capacity included requirement for postoperative critical care [odds ratio (OR)=2.92; 95% confidence interval (CI), 2.12–4.02; PConclusions: a significant proportion of patients presenting for surgery have experienced a previous cancellation for the same procedure. Cancer surgery is relatively protected, but bed capacity, including postoperative critical care requirements, are significant risk factors for previous cancellations.

Long-chain fatty acid (LCFA) movement into skeletal muscle involves a highly mediated process in which lipid rafts are utilized in the cellular membrane, involving numerous putative plasma membrane-associated LCFA transport proteins. The process of LCFA uptake and oxidation is of particular metabolic significance both at rest and during light to moderate exercise. A comprehensive systematic search of electronic databases was conducted to investigate whether exercise alters protein and/or gene expression of putative LCFA transport proteins. There were 31 studies meeting all eligibility criteria, of these 13 utilized an acute exercise protocol and 18 examined chronic exercise adaptations. Seventeen involved a study design incorporating an exercise stimulus, while the remaining 14 incorporated a combined exercise and diet stimulus. Divergent data relating to acute exercise, as well as prolonged exercise training (≥3 weeks), on protein content (PC) response was identified for proteins CD36, FABPpm and CAV1. Messenger ribonucleic acid (mRNA) data did not always correspond to functional PC, supporting previous suggestions of a disconnect due to potentially limiting factors post gene expression. The large array of study designs, cohorts, and primary dependent variables within the studies included in the present review elucidate the complexity of the interaction between exercise and LCFA transport proteins. Summary of the results in the present review validate the need for further targeted investigation within this topic, and provide an important information base for such research. J. Cell. Physiol. 231: 1671-1687, 2016. © 2015 Wiley Periodicals, Inc.

The purpose of this study was to examine the effect of the angiotensin I-converting enzyme (ACE) I/D gene polymorphism on athletic status and physical performance of well-trained Malaysian athletes. 180 well-trained athletes (34 endurance, 41 strength/power, and 105 intermittent athletes) and 180 sedentary controls involved in the study. A sample of DNA was retrieved via buccal cell from each subject and the polymorphism was then identified through Polymerase Chain Reaction. The endurance performance and leg strength of athletes were evaluated with twenty meters Yo–Yo intermittent recovery level 2 and maximal voluntary contraction tests, respectively. Chi-square test and one-way ANOVA were used for data analysis. The II genotype was more prevalent among the endurance athletes (0.38) compared to the intermittent athletes (0.14), strength/power athletes (0.05), and controls (0.31) (p = 0.00). Conversely, the DD genotype was more prevalent among the strength/power athletes (0.66) compared to the endurance athletes (0.26), intermittent athletes (0.47), and controls (0.15). The endurance performance was not significantly associated with ACE genotype in the athletes (p = 0.828). However, athletes with the DD genotype had a better result for leg strength (113.8 ± 36.2) compared to those with the II (96.2 ± 28.0) and the ID (112.2 ± 33.5) genotypes (p = 0.047). This study reaffirms previous finding reported in Caucasian samples for the association of I and D alleles with endurance and strength/power performance, respectively. The finding of this study highlights the importance of genetic screening in identifying future sporting talents.

The therapeutic effect of exercise in promoting mental health is well known, and there is a growing body of evidence for incorporating physical activity-based interventions in the management of substance use disorders (SUD). A particular challenge in this area is a lack of standardized testing protocols between studies and clear descriptive statistics on the capacity of the SUD patient to perform exercise. Therefore, an essential starting point for new studies that seek to incorporate exercise into usual care therapy for SUD is an appropriate suite of baseline fitness assessments that include measures of aerobic capacity as well as muscular strength and/or endurance. We present here the methods and notes of our recent experiences in implementing baseline fitness testing of a patient population undergoing in-patient treatment for SUD. The tests described here have been adapted from freely available standardized tests that were developed for implementation with the general population. It is hoped that these experiences aid in the development of patient-specific physical activity programs that assist in the management of SUD.