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Context Diet quality indices (DQIs) were developed to score and rank adherence to dietary patterns in observational studies, but their use to measure changes in diet quality in intervention trials is becoming common in the literature. Objective This systematic review and meta-analysis aimed to assess the effectiveness of DQIs to measure change in diet quality in intervention trials. Data Sources MEDLINE, CINAHL, Embase, and the Cochrane Central Register of Controlled Trials databases were searched from January 1994 to June 2020. Two reviewers independently completed full-text screening. Eligible studies were randomized controlled trials that used validated a priori DQIs to measure change in diet quality in adults. Data Extraction Data were extracted by an independent reviewer and reviewed by the research team. Risk of bias was assessed by the Cochrane Collaboration’s Risk of Bias 2.0 tool. Data Analysis The 34 included studies (52% of reviewed studies, 0.6% of initially identified studies) used 10 different DQIs, 7 of which were able to measure significant change in diet quality. Meta-analyses of pooled results demonstrated change in the Healthy Eating Index (MD 5.35; 95%CI, 2.74–7.97; P Conclusion DQIs are responsive to change in diet quality in intervention trials when the index used reflects the dietary changes made and the study is adequately powered. The appropriate selection of a DQI to suitably match dietary changes and study populations is important for future dietary intervention trials. Systematic Review Registration PROSPERO registration no. CRD42020181357.

Introduction: Research to date, provides equivocal evidence regarding the influence of heat stress, heat strain, and more specifically, elevated exercise-induced core temperature on cognitive performance. This review sought to identify differences in how specific cognitive tasks were affected by increases in core body temperatures. Methods: Included papers (N = 31) measured cognitive performance and core temperature during exercise, while experiencing heightened thermal stress. Cognitive tasks were classified as: cognitive inhibition, working memory, or cognitive flexibility tasks. Results: Independently, core temperature changes were not sufficient predictors of cognitive performance. However, reaction time, memory recall, and Stroop tasks appeared to be most effective at identifying cognitive changes during heightened thermal strain. Discussion: Alterations in performance were more likely to arise under increased thermal loads, which were typically associated with cumulative physiological stressors, such as elevated core temperatures, occurring alongside dehydration, and prolonged exercise durations. Future experimental designs should consider the relevance, or futility of assessing cognitive performance in activities that do not elicit a considerable degree of heat strain, or physiological load.

Multivalent antigen display is a fast-growing area of interest towards broadly protective vaccines. Current nanoparticle-based vaccine candidates demonstrate the ability to confer antibody-mediated immunity against divergent strains of notably mutable viruses. In coronaviruses, this work is predominantly aimed at targeting conserved epitopes of the receptor-binding domain. However, targeting other conserved non-RBD epitopes could further limit the potential for antigenic escape. To further explore new potential targets, we engineered protein nanoparticles displaying CoV_S-2P trimers derived from MERS-CoV, SARS-CoV-1, SARS-CoV-2, hCoV-HKU1, and hCoV-OC43 and assessed their immunogenicity in mice. Monotypic SARS-1_S-2P nanoparticles elicited cross-neutralizing antibodies against MERS_S and protected against MERS-CoV challenge. MERS and SARS-I53_dn5 nanoparticles elicited S1-focused antibodies, revealing a conserved site on the NTD. Moreover, mosaic nanoparticles co-displaying distinct CoV_S-2P trimers elicited antibody responses to distant cross-group antigens while protecting against MERS challenge despite diminished valency of MERS_S-2P. Our findings will inform further efforts towards the development of pan-coronavirus vaccines.

Previous studies have demonstrated that response inhibition training can modify the appeal of palatable and energy-dense foods, thus serving as a potential intervention for weight management, via changes in food selection and intake. However, empirical findings of efficacy have been inconsistent across studies due to heterogenous approaches to measuring salient appetitive outcomes, training implementation strategies, and sample recruitment. Systematic assessment of both affective and motivational components of food reward may help characterise to what extent devaluation can be generalised to nutritionally similar foods post-training. In this mixed factorial experiment, a non-clinical, adult sample completed time-matched single sessions with mobile app-based response inhibition training and control tasks of short (12 min; n = 27) or long (20 min; n = 25) duration. Participants were assessed on two discrete facets of food reward pre- and post-training: pleasure (i.e., explicit liking) and desire (i.e., implicit wanting) for non-specific (i.e., novel) food stimuli differing in energy-density. Consumption of snacks categorised by energy density was also assessed in a laboratory ad libitum taste test post-training. No significant differences were found between intervention and control sessions on explicit liking or implicit wanting for non-specific energy-dense foods. Moreover, participants ate a similar volume of snack foods during both sessions. Training duration did not significantly moderate differences between intervention and control sessions in primary outcomes. Variance between intervention and control sessions in chocolate intake and frequency of choice for energy-dense foods, but not explicit liking, was associated with a higher BMI. Methodological and theoretical implications for appropriate intervention implementation and underlying mechanisms, respectively, are discussed.

SUMMARYBackgroundVaccination has helped to mitigate the COVID-19 pandemic. Ten traditional and novel vaccines have been listed by the World Health Organization for emergency use. Additional alternative approaches may better address ongoing vaccination globally, where there remains an inequity in vaccine distribution. GBP510 is a recombinant protein vaccine, which consists of self-assembling, two-component nanoparticles displaying the receptor-binding domain (RBD) in a highly immunogenic array.MethodsWe conducted a randomized, placebo-controlled, observer-blinded, phase 1/2 trial to evaluate the safety and immunogenicity of GBP510 (2-doses at a 28-day interval) adjuvanted with or without AS03 in adults aged 19–85 years. The main outcomes included solicited and unsolicited adverse events; anti-SARS-CoV-2 RBD IgG antibody and neutralizing antibody responses; T-cell immune responses.FindingsOf 328 participants who underwent randomization, 327 participants received at least 1 dose of vaccine. Each received either 10 μg GBP510 adjuvanted with AS03 (n = 101), 10 μg unadjuvanted GBP510 (n = 10), 25 μg GBP510 adjuvanted with AS03 (n = 104), 25 μg unadjuvanted GBP510 (n = 51), or placebo (n = 61). Most solicited adverse events were mild-to-moderate in severity and transient. Higher reactogenicity was observed in the GBP510 adjuvanted with AS03 groups compared to the non-adjuvanted and placebo groups. Reactogenicity was higher post-dose 2 compared to post-dose 1, particularly for systemic adverse events. The geometric mean concentrations of anti-SARS-CoV-2-RBD IgG antibody reached 2163.6/2599.2 BAU/mL in GBP510 adjuvanted with AS03 recipients (10 μg/25 μg) by 14 days after the second dose. Two-dose vaccination with 10 μg or 25 μg GBP510 adjuvanted with AS03 induced high titers of neutralizing antibody via pseudovirus (1369.0/1431.5 IU/mL) and wild-type virus (949.8/861.0 IU/mL) assays.InterpretationGBP510 adjuvanted with AS03 was well tolerated and highly immunogenic. These results support further development of the vaccine candidate, which is currently being evaluated in Phase 3.FundingCoalition for Epidemic Preparedness InnovationsRESEARCH IN CONTEXTEvidence before this studyWe searched PubMed for research articles published by December 31, 2021, using the terms “COVID-19” or “SARS-CoV-2,” “vaccine,” and “clinical trial.” In previously reported randomized clinical trials, we found that mRNA vaccines were more immunogenic than adenovirus-vectored vaccines. Solicited adverse events were more frequent and more severe in intensity after the first dose compared to the second dose for adenovirus-vectored vaccines, whereas they increased after the second dose of mRNA or recombinant spike-protein nanoparticle vaccines.Added value of this studyThis is the first human study evaluating the immunogenicity and safety of recombinant SARS-CoV-2 protein nanoparticle with and without adjuvant AS03, designed to elicit functional cross-protective responses via receptor-binding domain (RBD). Both 10 and 25 μg of GBP510 with AS03 formulations were well tolerated with an acceptable safety profile. Potent humoral immune responses against the SARS-CoV-2 RBD were induced and peaked by day 42 (14 days after the second dose). In addition, GBP510 adjuvanted with AS03 elicited a noticeable Th1 response, with production of IFN-γ, TNF-α, and IL-2. IL-4 was inconsistent and IL-5 nearly inexistent response across all groups.Implications of the available evidenceThe results from this phase 1/2 trial indicate that GBP510 adjuvanted with AS03 has an acceptable safety profile with no vaccine-related serious adverse events. Two-dose immunization with GBP510 adjuvanted with AS03 induced potent humoral and cellular immune responses against SARS-CoV-2.

Bariatric surgery continues to be the most reliable treatment for the disease of obesity. Despite excellent results, some patients experience weight recurrence with or without concomitant recurrence of co-morbidities. There is currently no standard definition for clinically significant weight recurrence after bariatric surgery so that patients and clinicians have a platform from which to plan treatment. The Post-Operative Weight Recurrence (POWER) Task Force was formed by the American Society for Metabolic and Bariatric Surgery to address this aspect of the disease of obesity. This article reviews the literature of existing definitions for weight recurrence and their limitations. Furthermore, the term weight recurrence is introduced to replace weight regain or recidivism, and the term nonresponder is introduced to replace inadequate weight loss after surgery.

Marginal ulcer (MU) formation is a serious complication following Roux-en-Y Gastric Bypass (RYGB). Incidental data suggested a higher incidence of MU following conversion of Sleeve Gastrectomy to RYGB (S-RYGB). Herein, we evaluate the incidence of MU after primary versus secondary RYGB.After IRB approval, each institution's electronic medical record and MBSAQIP database were queried to retrospectively identify adult patients who underwent primary RYGB (P-RYGB), Gastric Banding to RYGB (B-RYGB), or S-RYGB between 2014 and 2019, with minimum 1 year follow-up. Patient demographics, operative data, and post-operative outcomes were compared. Numeric variables were compared via two-sample t test, Wilcoxon test or Kruskal Wallis rank sum test. Two-sample proportion test or Fisher's exact test was employed for categorical and binary variables. p 0.05 marked statistical significance.748 patients underwent RYGB: P-RYGB n = 584 [78.1%]; B-RYGB n = 98 [13.1%]; S-RYGB n = 66 [8.8%]. Most patients were female (83.2%). Mean age was 45.7 years. Forty-six (n = 6.1%) patients developed MU, a median of 14 ± 32.2 months (range 0.5-82) post-operatively. Incidence of MU was significantly higher for patients undergoing S-RYGB (n = 9 [13.6%]), compared to P-RYGB (n = 34 [5.8%]) and B-RYGB (n = 3 [3.1%]) (p = 0.023). Median time (months) to MU was significantly shorter for patients who underwent S-RYGB (5 ± 6) compared to P-RYGB or B-RYGB (19 ± 37.5) (p = 0.035). Among those who developed MU, there was no significant difference in H. pylori status, NSAID, steroid, or tobacco use, irrespective of operation performed.In this multi-institutional cohort, patients who underwent S-RYGB had a significantly higher incidence of MU than those with P-RYGB or B-RYGB. Further research is needed to elucidate its pathophysiology and prevention strategies.

Background Interdisciplinary education (IDE) has been proposed as a means to improve patient safety by enhancing the performance of diverse health care teams. The improved camaraderie between members of different specialties may enhance communication and can foster a more supportive and positive work environment. Objective This study was aimed to assess the effect of IDE on the procedural skills of general surgery (GS) and emergency medicine (EM), as well as the perceptions that GS and EM residents have of one another. Methods EM and GS residents participated in two separate IDE sessions (4 months apart) designed to teach extended focused assessment with sonography in trauma (e-FAST), tube thoracostomy, and complex wound closure. Surveys were administered to determine the effects that IDE had on confidence in performing bedside procedures, perceptions of IDE, and perceptions of one another's specialty. Survey responses were recorded using a 5-point Likert's scale. Results Nine GS residents and 10 EM residents participated in the entire study. Significant improvements in the confidence levels of performing bedside procedures were noted among both groups of residents. We also report a significant improvement in the perceived respect and communication between EM and GS residents. Conclusions Although further studies with a larger sample size are required, we have shown that IDE can improve the confidence levels of EM and GS residents in performing tube thoracostomy, e-FAST, and complex wound closure. These IDE sessions also improve the perceptions that the residents have of one another. IDE is a useful tool and may translate into improved consultation, collaboration, and patient care.

Rapid generation of diagnostics is paramount to understand epidemiology and to control the spread of emerging infectious diseases such as COVID-19. Computational methods to predict serodiagnostic epitopes that are specific for the pathogen could help accelerate the development of new diagnostics. A systematic survey of 27 SARS-CoV-2 proteins was conducted to assess whether existing B-cell epitope prediction methods, combined with comprehensive mining of sequence databases and structural data, could predict whether a particular protein would be suitable for serodiagnosis. Nine of the predictions were validated with recombinant SARS-CoV-2 proteins in the ELISA format using plasma and sera from patients with SARS-CoV-2 infection, and a further 11 predictions were compared to the recent literature. Results appeared to be in agreement with 12 of the predictions, in disagreement with 3, while a further 5 were deemed inconclusive. We showed that two of our top five candidates, the N-terminal fragment of the nucleoprotein and the receptor-binding domain of the spike protein, have the highest sensitivity and specificity and signal-to-noise ratio for detecting COVID-19 sera/plasma by ELISA. Mixing the two antigens together for coating ELISA plates led to a sensitivity of 94% (N=80 samples from persons with RT-PCR confirmed SARS-CoV2 infection), and a specificity of 97.2% (N=106 control samples).

Introduction High-fidelity team-based simulation has been identified as an effective way of teaching and evaluating both technical and nontechnical skills. Several studies have described the benefits of this modality in a variety of acute care settings, but a lack of standardized methodologies has resulted in heterogeneous findings. Few studies have characterized high fidelity simulation across a broad range of acute care settings and integrated the latest evidence on its educational and patient impact. Methods The MEDLINE, EMBASE, Cochrane Library, and PsycINFO databases were searched for empirical studies from the last 10 years, investigating high fidelity team-based simulation in surgical, trauma, and critical care training curricula. Results Seventeen studies were included. Interventions and evaluations were comprehensively characterized for each study and were discussed in the context of four overarching acute care settings: the emergency department/trauma bay, the operating room, the intensive care unit, and inpatient ad hoc resuscitation teams. Conclusions The use of high-fidelity team-based simulation has expanded in acute care and is feasible and effective in a wide variety of specialized acute settings, including the emergency department/trauma bay, the operating room, the intensive care unit, and inpatient ad hoc resuscitation teams. Training programs have evolved to emphasize team-based, multidisciplinary education models and are often conducted in situ to maximize authenticity. In situ simulations have also provided the opportunity for system-level improvement and discussions of complex topics such as social hierarchy. There is limited evidence supporting the impact of simulation on patient outcomes, sustainability of simulation efforts, or cost-effectiveness of training programs. These areas warrant further research now that the scope of utilization across acute care settings has been characterized.

This book assesses the impact of austerity measures introduced by UK and EU governments for public and third sector organisations providing sport-related services and for service users.

© 2017 Informa UK Limited, trading as Taylor & Francis Group This study seeks to understand participation levels in sport across socio-demographic groups, specifically for the period 2008–14, in the context of austerity measures taken by central government resulting in local authority income and expenditure reductions. Participation levels over time were analysed using data from the Active People Survey (APS), which was the preferred method for measuring participation by Sport England until its replacement in 2015. Budgetary constraints in local authorities have subsequently resulted in an expenditure decrease for non-discretionary services including ‘sport development and community recreation’. This area of expenditure forms one component of sport-related services and primarily focuses on raising participation in ‘hard-to-reach’ groups. The study found that policy goals associated with raising and widening participation were not met to any significant degree between 2008 and 2014 as participation levels have changed little for lower income ‘hard-to-reach’ groups. It is claimed that this outcome is in part due to austerity measures impacting on local authority expenditure. This study has implications for policymakers and practitioners as it illustrates both the challenges faced in setting and delivering policy aimed at raising participation levels in ‘hard-to-reach’ groups, particularly in the context of austerity, and the difficulties associated with measuring participation.

The American Board of Surgery will require graduating surgical residents to achieve proficiency in endoscopy. Surgical simulation can help residents to prepare for this proficiency test, accelerate skill acquisition, shorten the learning, and improve patient safety. Currently, endoscopic simulators are extremely cost-prohibitive. We therefore designed an inexpensive physical endoscopic simulator to (1) facilitate Fundamentals of Endoscopic Surgery skills training and (2) teach basic colonoscopy skills, for

Purpose – The purpose of this paper is to examine the actual and potential utility of social return on investment (SROI) analysis as an instrument to strengthen the financial and social “case” for local authority sport and recreation services (SRS) in the context of recent research by the Association of Public Service Excellence. Design/methodology/approach – The research for APSE, undertaken by the author, consisted of a survey and a series of interviews over 18 months with policy officers within leisure services across local authorities in England. Data on “making the case” for SRS is extracted from this research. Findings – It is argued that SROI has utility where it can demonstrate the contribution of sport, physical activity and recreation to health policy, adult social care, education, youth crime reduction, place shaping agendas and community engagement, for example. However, findings of the APSE research imply that although SROI offers use value in making a case for retaining services, this method of assessment may not be widely employed for a number of political and practical reasons. Research limitations/implications – The research is limited to a sample of 55 local authorities in England from which generalisations are made. Practical implications – In the context of the introduction of the Social Value Act in 2013, SROI offers use value in making a case for retaining or adapting discretionary services within emerging models of strategic commissioning. Implementation will however be challenging for SRS. Originality/value – It is argued that without an evidence base, it is unlikely that a case can be made for retaining discretionary services that benefit local communities.

Based on research undertaken by the author for the Association of Public Service Excellence (APSE), this paper assesses local authority sport services in England in the context of an economic recession since 2008, the election of a coalition government in 2010 and subsequent reductions in local government finance. The study took the form of a review of secondary sources, a nationwide online survey of heads of local council sport services (n = 95) and a series of follow-up interviews with senior local authority personnel and sector representatives (n = 55). The paper focuses on one theme to emerge from the study, namely, the relative decline of Sport for All, that is, of strategies designed to increase sport and physical activity among the general population. The study found that competing organisational models of sport services across England largely determine the retention or curtailment of Sport for All programmes. In the “ensuring council” model, sport services retain the core capacity to shape and del...

In the context of significant reductions to local government finance since the election of a coalition government in 2010, this paper examines the impact on sport services. In particular, the research focuses on change to policy, governance and modes of service delivery. The findings are extracted from research conducted by the author for the Association of Public Service Excellence (APSE) that consists of a national survey (n = 95) and interviews with senior officers (n = 55). Findings signal the acceleration of an established trend away from a direct provision of services, within the ‘ensuring’ council framework, towards outsourcing services via a ‘commissioning’ council framework. Within the coalition government’s Big Society agenda, the research also found that a small number of council sport services are adapting to financial pressures by adopting a ‘cooperative’ council framework for service delivery. The paper discusses the wider consequences of political and financial change for sport services in ...

Upper and lower endoscopy is an important tool that is being utilized more frequently by general surgeons. Training in therapeutic endoscopic techniques has become a mandatory requirement for general surgery residency programs in the United States. The Fundamentals of Endoscopic Surgery has been developed to train and assess competency in these advanced techniques. Simulation has been shown to increase the skill and learning curve of trainees in other surgical disciplines. Several types of endoscopy simulators are commercially available; mechanical trainers, animal based, and virtual reality or computer-based simulators all have their benefits and limitations. However they have all been shown to improve trainee's endoscopic skills. Endoscopic simulators will play a critical role as part of a comprehensive curriculum designed to train the next generation of surgeons. We reviewed recent literature related to the various types of endoscopic simulators and their use in an educational curriculum, and discuss the relevant findings.

The concept of negative refraction is attracting a lot of attention. The initial ideas and the misconceptions that have arisen are discussed in sufficient detail to understand the conceptual structure that binds negative refraction to the existence of backward wave and forward wave phenomena. A presentation of the properties of isotropic media supporting backward waves is followed by a discussion of negative phase velocity media, causality, anisotropic crystals and some connections to photonic crystals. The historical background is always coupled to a detailed presentation of all the issues. The paper is driven numerically and is illustrated with the outcomes of original FDTD simulations.

Bajc’s edited collection, Surveilling and Securing the Olympics, provides a series of critical insights into the complex relationships between sports organisations, the government and military arms...

As implied by its name, magneto-optics embraces all activities that concern the interaction of light with a magnetic material. A vast range of substances can be accessed for such investigations, and insulating materials such as YIG (yttrium iron garnet) are popular for isolator applications. It is metallic materials, however, that are discussed in this tutorial, so that the basics of the all-important Kerr effect can be exposed in a manner that exploits popular ferromagnetic materials that yield effects that are of practical use. In this spirit, the discussion will always refer to metallic conductors, even though, of course, all magneto-optic materials can display the full range of magneto-optic properties to a greater or lesser degree. Of the five ferromagnetic elements, cobalt, iron, and nickel are by far the most important. In bulk form, each material contains what are called domains. Domains are magnetised subregions that, although quite often chaotically related to each other, can be brought into alignment by the application of a modest applied magnetic field. In this way, a magnetic material and its magnetic state can be organised to have an electromagnetic impact simply by reflecting p-polarised light from it. In fact, the magnetisation of the material produces a small rotation of the plane of polarisation of this type of incident light. Upon reflection from a magnetised material, an incident plane p-polarised light beam can become elliptically polarised, with the principal axis moving a few degrees away from the axis of the incoming light. Such a rotation is known as the Kerr effect, named after the Rev. John Kerr, who announced his discovery in 1888. Kerr could not have imagined just how significant this discovery was; its impact on data storage technologies is still holding out fantastic prospects. As discussed below, magnetic materials can be magnetised in a number of ways. A popular orientation for the magnetisation is to be perpendicular to the optical reflection surface. It should also be possible to observe such a magneto-optic effect using only a nanomagnet that is a member of an array of nanomagnets. The aim is to deposit a massive number of isolated magnetised units in the multiterabit range over a surface so that each unit can be interrogated by bouncing a laser beam off of it. The ‘bits’ are digital data that can be read optically through the Kerr effect. This is not the only use for Kerr effect; it is genetically useful as a tool for monitoring all types of magnetic states. The data storage aspect is amazing, however, when it is realised that the print collection in the U.S. Library of Congress is about 10 terabytes. The fact that 1 terabyte represents about 50,000 trees turned into printed paper makes the development of magneto-optic storage even more imperative and exciting.

Metamaterials embody exciting prospects for a new generation of novel photonic devices. From their initial emergence as a physical construct in the GHz domain at the start of the 21st century [1–3], they have attracted a significant amount of global interest [4–13] with considerable effort being undertaken to extend their operation into the THz window and even optical regimes [14,15]. However, as they stand, early theoretical indications are that losses will cause potential problems for all possible frequencies and, in particular, kill any opportunity [16] for a useful metamaterial operating around and above 30THz. Such losses are inevitably closely linked to the resonant behaviour of the metaparticles and is addressed here by the placement of active diodes onto a form of metallic split-ring. The use of diodes to create a nonlinear magnetic response [16] and to create tunability [17] has already been discussed but active diodes [18] not only promise means of reducing losses but they can be deployed to produce an overall gain [19]. This behaviour is readily scalable from GHz to THz and even to nanowire [20] and nanoparticle-based metamaterials [21] operating in the optical frequency window. Nevertheless, it is highlighted here that instabilities could present a serious issue. From an investigation of the dispersion relation for a plane wave, a number of conditions are derived that identify the limits placed upon the system parameters, in order to ensure stable overall gain. Any examination of loss, or gain, must, however, be conducted from the perspective of the entire metamaterial, including the permittivity. Depending on the level of sophistication required in the fabrication technique, split-rings may be engineered with different shapes and deployed in a number of different arrays. The most popular have either a circular, or square shape. The term “split-ring” is treated here as a generic name and is not necessarily indicative of a specific shape.