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Objective: Web-based dietary interventions could support healthy eating. The Advice, Ideas and Motivation for My Eating (Aim4Me) trial investigated the impact of three levels of personalised web-based dietary feedback on diet quality in young adults. Secondary aims were to investigate participant retention, engagement and satisfaction. Design: Randomised controlled trial. Setting: Web-based intervention for young adults living in Australia. Participants: 18–24-year-olds recruited across Australia were randomised to Group 1 (control: brief diet quality feedback), Group 2 (comprehensive feedback on nutritional adequacy + website nutrition resources) or Group 3 (30-min dietitian consultation + Group 2 elements). Australian Recommended Food Score (ARFS) was the primary outcome. The ARFS subscales and percentage energy from nutrient-rich foods (secondary outcomes) were analysed at 3, 6 and 12 months using generalised linear mixed models. Engagement was measured with usage statistics and satisfaction with a process evaluation questionnaire. Results: Participants (n 1005, 85 % female, mean age 21·7 ± 2·0 years) were randomised to Group 1 (n 343), Group 2 (n 325) and Group 3 (n 337). Overall, 32 (3 %), 88 (9 %) and 141 (14 %) participants were retained at 3, 6 and 12 months, respectively. Only fifty-two participants (15 % of Group 3) completed the dietitian consultation. No significant group-by-time interactions were observed (P > 0·05). The proportion of participants who visited the thirteen website pages ranged from 0·6 % to 75 %. Half (Group 2 = 53 %, Group 3 = 52 %) of participants who completed the process evaluation (Group 2, n 111; Group 3, n 90) were satisfied with the programme. Conclusion: Recruiting and retaining young adults in web-based dietary interventions are challenging. Future research should consider ways to optimise these interventions, including co-design methods.

Osteoarthritis (OA) is a debilitating condition affecting an individual’s quality of life in multiple ways. However, little is known about about the experiences of täne (men) Māori living with OA in Aotearoa New Zealand. We aimed to explore the lived experiences of ngā tāne Māori with OA. This qualitative study was guided by tikanga and kaupapa Māori philosophies. Interviews were conducted in a semi-structured method, with seven tāne Māori living with OA. Key themes were identified and developed from the data through thematic analysis, and were informed by Tā Mason Durie’s Māori health frameworks, Te Whare Tapa Whā and Te Pae Māhutonga. Four themes developed from the data and were named: (1) The interface of masculine embodiment and mana, (2) Taha whānau and connection as central to ngā tāne Māori wellbeing, (3) The benefits of taha wairua (spiritual wellbeing), and (4) Te urutau kia uru ki te punaha tiaki hauora: Adapting to access the health-care system. OA places a significant burden on ngā tāne Māori and their whānau, impacting on all aspects of hauora (health). The unique lived experiences and impact on wider whānau of Māori living with OA indicates the need to consider te ao Māori (Māori world view) when developing clinical services and a Model of Care for OA.

Physiotherapists’ and general practitioners’ (GPs) treatment knowledge affects the management of people with knee osteoarthritis (OA), but little is known about the OA referral decisions and treatment knowledge of these clinicians in New Zealand. Data were collected from New Zealand registered physiotherapists and GPs (n = 272) using an online vignette-based questionnaire. Approximately two-thirds (63%, n = 172) of participants stated they would likely refer the hypothetical patient with knee OA to another profession. Participants indicated they would refer the woman between the two professions (73%, n = 57 GPs would refer to a physiotherapist; 47%, n = 92 physiotherapists would refer to a GP). However, few participants indicated they would refer the woman to other health professionals (such as 19%, n = 52 would refer to a dietitian). The majority of participants reported they would recommend education (98%, n = 267), therapeutic exercises (92%, n = 251) and weight-loss advice (87%, n = 237) as treatments for knee OA. These results indicate that first-line knee OA treatment knowledge of New Zealand GPs and physiotherapists are generally in keeping within international guidelines. However, promoting interprofessional collaboration with other health professions, such as dietetics, and providing education regarding treatments not recommended for OA is needed to meet all first-line treatment recommendations.

Osteoarthritis (OA) is a prevalent and costly condition. Evidence-based clinical guidelines recommend three core treatments for OA: education, exercise, and weight loss (as appropriate). However, the translation of evidence into practice is limited. Clinical guidelines do not provide information on how to implement recommendations in local care settings. In New Zealand, management of people with OA in primary care is inconsistent and fragmented. Clinicians and researchers have made a call for a New Zealand OA model of care to close this evidence-practice gap and optimise primary care OA management nationwide. A model of care is a condition specific implementation strategy that outlines what care should be funded and delivered, who should provide it, and where and how care should be addressed. Various models of care for OA have been implemented with promising results in Australia, the United Kingdom (UK) and Europe. One programme that is translating guidelines into practice is the Model OsteoArthritis Consultation (MOAC). Empirical evaluations of the MOAC in the UK and Europe have demonstrated greater delivery of core treatments, better service quality, and improved patient outcomes. This article makes a case for piloting the MOAC in New Zealand as an implementation strategy to optimise primary care management of OA.

BACKGROUND AND PURPOSE Prostacyclin mimetics express potent vsoactive effects via prostanoid receptors which are not defined unequivocally, as to date no study has considered sex as a factor. The aim of this study was to determine the contribution of IP and EP3 prostanoid receptors to prostacyclin mimetic Iloprost mediated responses, whether KV 7.1-5 channels represent downstream targets of selective prostacyclin-IP-receptor agonist MRE-269 and the impact of the oestrus cycle on vascular reactivity. EXPERIMENTAL APPROACH Within 2nd order mesenteric arteries (MAs) from male and female Wistar rats, we determined; 1.) relative mRNA transcripts for EP1-4 (Ptger1-4 ), IP (Ptgi) and TXA2 (Tbxa) prostanoid receptors via RT-qPCR; 2.) The effect of Iloprost, MRE-269, isoprenaline and ML277 on pre-contracted arterial tone in the presence of inhibitors of prostanoid receptors, potassium channels and molecular interreference of KV 7.1 via wire-myograph; 3.) Oestrus cycle stage via histological changes in cervical cell preparations. KEY RESULTS Iloprost evoked a bi-phasic response in male MAs, at concentrations ≤100nmol-L-1 relaxing, then contracting the vessel at concentration ≥300nmol-L-1 in a process attributed to IP and EP3 receptors respectively. Secondary contraction was absent in the females, which was associated with a reduction in Ptger3. Pharmacological inhibition and molecular interference of KV 7.1 significantly attenuated relaxations produced by the selective IP-receptor agonist MRE-269 in male and female Wistar in Diestrus /Metoestrous, but not Pro-oestrus/Oestrus. CONCLUSIONS AND IMPLICATIONS Stark sexual dimorphisms in Iloprost mediated vasoactive responses are present within MAs. KV 7.1 is implicated in IP-receptor mediated vasorelaxation and is impaired by the Oestrus cycle.

Background Idiopathic toe walking (ITW) is an exclusionary diagnosis. There has been limited exploration of lower limb active range of motion and strength measures in children with ITW. This researched aimed to determine any differences in lower limb muscle active range of motion and strength in children who have ITW, compared to normative data collected from children who displayed typical gait. Methods Children were recruited with had a diagnosis of ITW, aged between 4 and 10 years, and no recent treatment. Data collected included parent reported data such as time spent toe walking, percentage of time spent toe walking, and clinician collected data such as age, height and weight. Joint ranges of motion and strength measures were collected by an experience clinician. Active and weight bearing joint ranges of motion were evaluated with a goniometer or digital inclinometer. Lower limb muscle strength measures were evaluated with a hand-held dynamometer. Published normative data sets were used for comparison. Measures were analysed with regression analyses to determine differences between groups in different measures, considering measures known to impact range and strength. Odds ratios (OR), 95% confidence intervals (CI) and p values were reported. Results Twenty-six children with ITW participated. Reduced weight bearing ankle range of motion, when measured with the knee bent, was associated with being in the ITW group (p = 0.009), being older (p p = 0.015). For all lower limb strength measures, excluding hip external rotation, children who displayed greater strength, did not toe walk (p p p Conclusion Children with ITW displayed reduced overall plantar and dorsiflexion at the ankle, compared to non-toe walking children. Reduced plantarflexion is children with ITW has not been described before, however reduced dorsiflexion is commonly reported. Children with ITW were weaker in many lower limb measures, even when age and weight were considered. This should lead clinicians and researchers to pay greater attention to lower limb strength measures in this population.

INTRODUCTION/AIMS We explored correlates of night-time and exercise-associated lower limb cramps in participants of the 1000 Norms Project. METHODS A volunteer community sample of healthy people aged ≥18 y underwent assessment of motor function and physical performance, and were questioned about muscle cramps in the previous 3 mo. RESULTS Of 491 (221 female) participants age 18-101 y (mean: 59.12; SD: 18.03), about 1 in 3 experienced night-time lower limb cramps, and about 1 in 4 experienced exercise-associated lower limb cramps. For night-cramps, a one unit increase in Beighton score (greater whole-body flexibility) was associated with a 31% reduced odds of cramps (odds ratio [OR] = 0.69, 95% confidence interval [CI]:0.45, 0.99) and passing all three lesser-toe strength tests was associated with 50% reduced odds of cramps (OR = 0.50, 95% CI: 0.32, 0.78). For exercise-associated cramps, participants in the fourth (lowest arch) quartile of Foot Posture Index were 2.1 times (95% CI: 1.11, 3.95) more likely to experience cramps than participants in the first (highest arch) quartile. Odds of experiencing both types of cramps versus no cramps were lower with passing all three lesser-toe strength tests (OR = 0.40, 95% CI: 0.19, 0.85) and better performance in the six-minute walk test (OR = 0.997, 95% CI: 0.996, 0.998). DISCUSSION People who experienced both exercise-associated and night-time cramps were less functional. The association between night-time cramps with less whole-body flexibility and reduced lesser-toe flexor strength should be explored to determine causation. Planovalgus (low-arched) foot type was independently associated with exercise-associated cramps. The effectiveness of foot orthoses for secondary prevention of exercise-associated cramps in people with low-arched feet should be explored.

Kcnq-encoded KRT-qPCR, immunocytochemistry, proximity ligation assay and wire myography were performed in renal and mesenteric arteries. Circulating sex hormone concentrations were determined by liquid chromatography-tandem mass spectrometry. Whole-cell electrophysiology was undertaken on cells expressing KThe KGPER1 signalling decreased K

Background The relationship between diet quality and health care costs is unclear. Objective The aim of this study was to investigate the relationship between baseline diet quality and change in diet quality over time, with 15-year cumulative health care claims/costs. Design Data from a longitudinal cohort study were analyzed. Participants/setting Data for survey 3 (2001) (n = 7,868) and survey 7 (2013) (n = 6,349 both time points) from the 1946-1951 cohort of the Australian Longitudinal Study on Women’s Health were analyzed. Main outcome measures Diet quality was assessed using the Australian Recommended Food Score (ARFS). Fifteen-year cumulative Medicare Benefits Schedule (Australia’s universal health care coverage) data were reported by baseline ARFS quintile and category of diet quality change (“diet quality worsened” [ARFS change ≤ –4 points], “remained stable” [–3 ≤ change in ARFS ≤3 points], or “improved” [ARFS change ≥4 points]). Statistical analyses Linear regression analyses were conducted adjusting for area of residence, socioeconomic status, lifestyle factors, and private health insurance status. Results Consuming a greater variety of vegetables at baseline but fewer fruit and dairy products was associated with lower health care costs. For every 1-point increment in the ARFS vegetable subscale, women made 3.3 (95% CI, 1.6-5.0) fewer claims and incurred AU$227 (95% CI, AU$104-350 [US$158; 95% CI, US$72-243]) less in costs. Women whose diet quality worsened over time made more claims (median, 251 claims; quintile 1, quintile 3 [Q1; Q3], 168; 368 claims) and incurred higher costs (AU$15,519; Q1; Q3, AU$9,226; AU$24,847 [US$10,793; Q1; Q3, US$6,417; US$17,281]) compared with those whose diet quality remained stable (median, 236 claims [Q1; Q3, 158; 346 claims], AU$14,515; Q1; Q3, AU$8,539; AU$23,378 [US$10,095; Q1; Q3, US$5,939; US$16,259]). Conclusions Greater vegetable variety was associated with fewer health care claims and costs; however, this trend was not consistent across other subscales. Worsening diet quality over 12 years was linked with higher health care claims and costs.

Introduction: The Living Donor Navigator (LDN) program is one of several initiatives designed to help transplant candidates identify living donors with the help of a friend or family member advocate to speak on their behalf. More than half of advocates in the LDN program were the spouse or parent of the candidate and served in a caregiving role. Caregivers for patients awaiting transplantation have reported poorer quality of life than the general population, suggesting more support is needed for this vulnerable group. The purpose of this study was to understand whether the LDN program met the needs of advocates who were also caregivers for the transplant candidate. Methods: We performed a supplementary secondary qualitative analysis of a parent study conducted December 2017-January 2018 with 9 advocates who participated in the LDN program. Transcripts were reanalyzed from focus group discussions, concentrating on comments about caregiving or made by caregivers. Using manual coding and reflexive thematic analysis, we identified broad codes and major themes. Findings: Our re-analysis revealed one theme overlapping with our previous analysis (Support) and 2 new themes specific to caregiver advocates: Quality of Life and Fear. Caregivers agreed that the LDN program equipped them with tools to address these areas and best serve their simultaneous caregiver/advocate roles. Discussion: These analyses demonstrated that those who served as advocate and caregiver derived a benefit from the LDN program but had distinct needs from other advocates. These findings can inform continued refinement of the program and expansion to support needs of caregiver

Longitudinal fibular deficiency (LFD) is the most common congenital long bone deficiency. This study aimed to objectively assess the physical performance of children and adolescents with LFD compared with unaffected peers, and to examine trends over age for subgroups of the LFD population.Differences between children with LFD and unaffected peers were examined with hand-held dynamometry for lower-limb muscle strength, Six-Minute Walk Test, Timed up and down stairs test, Star Excursion Balance Test, and Standing long jump.Thirty-nine children with LFD and 284 unaffected peers participated. Children with LFD performed at a lower level than their unaffected peers, on all measures of physical performance (mean 2.1Children with LFD performed at a significantly lower level than unaffected peers on all measures of physical performance other than jumping. The largest differences were in older children. This paper provides baseline functional data for future interventions in LFD.Cross-sectional study.Implications for RehabilitationThis paper provides the first baseline functional data using validated objective measures on a consecutive cohort of children and adolescents with longitudinal fibular deficiency.Children with LFD performed significantly worse than their unaffected peers on all measures of physical performance other than jumping, with children falling further behind their peers as they age.Children who undergo an amputation typically have the most severe anatomical presentation and yet perform at an equivalent functional level.This paper identifies multiple modifiable impairments that represent potential opportunities for rehabilitation professionals to target with conservative treatment options to improve functional performance.

Background To evaluate the preliminary efficacy, feasibility and acceptability of the 3-month Body Balance Beyond (BBB) online program among Australian women with overweight/obesity and recent gestational diabetes mellitus. Methods Women were randomised into either: 1) High Personalisation (HP) (access to ‘BBB’ website, video coaching sessions, text message support); 2) Medium Personalisation (MP) (website and text message support); or 3) Low Personalisation (LP) (website only). Generalised linear mixed models were used to evaluate preliminary efficacy, weight, diet quality, physical activity levels, self-efficacy and quality of life (QoL) at baseline and 3-months. Feasibility was assessed by recruitment and retention metrics and acceptability determined via online process evaluation survey at 3-months. Results Eighty three women were randomised, with 76 completing the study. Self-efficacy scores showed significant improvements in confidence to resist eating in a variety of situations from baseline to 3-months in HP compared to MP and LP groups (P=.03). The difference in mean QoL scores favoured the HP compared to MP and LP groups (P=.03). Half of the women (HP n=17[81%], MP n=12[75%], LP n=9[56%]) lost weight at 3-months. No significant group-by-time effect were reported for other outcomes. Two-thirds of women in the HP group were satisfied with the program overall and 86% would recommend it to others, compared with 25% and 44% in the MP group, and 14% and 36% in the LP group, respectively. Conclusions Video coaching sessions were associated with improvements in QoL scores and self-efficacy, however further refinement of the BBB website and text messages support could improve program acceptability. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000162112, registered 5 February 2019.

The aim of this study was to establish reference values for rate of torque development (RTD) and muscle torque steadiness (MTS) of knee extensors across the lifespan, and evaluate if these measures are independently associated with Osteoarthritis Research Society International (OARSI)-recommended performance-based measures (6-minute walk test, 30-second chair stand test, stair climb test) and other clinical variables.In this cross-sectional observational study, knee extensor strength of 764 participants (12-89 years) from the 1000 Norms Project was assessed via fixed dynamometry. Age- and sex-stratified normative RTD (Nms-1 kg-1) and MTS (Nm kg-1) values were presented as means and 95% confidence intervals. Correlations and multiple regression analyses were calculated to identify factors (age, sex, height, weight, OARSI-recommended performance-based measures, Knee Injury and Osteoarthritis Outcome Score, vertical jump, long jump, grip strength, basic gait-related knee biomechanics) independently associated with RTD or MTS.Age- and sex-stratified normative RTD and MTS reference values were generated. Male subjects exhibited higher RTD but poorer MTS (less steady) than female subjects across all age groups. Better performance in OARSI-recommended performance-based measures, vertical jump, long jump, and grip strength were associated with greater RTD but poorer MTS. Thirty-second chair stand test, stair climb test, vertical jump, long jump, and grip strength were independent determinants of RTD and MTS.The RTD and MTS demonstrated associations with clinical variables relevant to knee osteoarthritis. The normative reference values generated may help identify the presence and extent of impairments in RTD and MTS associated with knee osteoarthritis and assist in developing responsive outcome measures for therapeutic trials.

Background Knowledge of which physical activity programs are most effective for older adults in different sub-populations and contexts is limited. The objectives of this rapid review were to: 1) Overview evidence evaluating physical activity programs/services for older adults; and 2) Describe impact on physical activity, falls, intrinsic capacity (physical domain), functional ability (physical, social, and cognitive/emotional domains), and quality of life. Methods We conducted a rapid review of primary studies from 350 systematic reviews identified in a previous scoping review (March 2021: PEDro, MEDLINE, CINAHL, Cochrane Database). For Objective 1, we included intervention studies investigating physical activity programs/services in adults ≥ 60 years. Of these, we included good quality (≥ 6/10 PEDro scale) randomised controlled trials (RCTs) with ≥ 50 participants per group in Objective 2. Results Objective 1: Of the 1421 intervention studies identified from 8267 records, 79% were RCTs, 87% were in high income countries and 39% were good quality. Objective 2: We identified 87 large, good quality RCTs (26,861 participants). Overall activity promotion, structured exercise and recreation/sport had positive impacts (≥ 50% between-group comparisons positive) across all outcome domains. For overall activity promotion (21 intervention groups), greatest impacts were on physical activity (100% positive) and social outcomes (83% positive). Structured exercise (61 intervention groups) had particularly strong impacts on falls (91% positive), intrinsic capacity (67% positive) and physical functioning (77% positive). Recreation/sport (24 intervention groups) had particularly strong impacts on cognitive/emotional functioning (88% positive). Multicomponent exercise (39 intervention groups) had strong impacts across all outcomes, particularly physical activity (95% positive), falls (90% positive) and physical functioning (81% positive). Results for different populations and settings are presented. Conclusion Evidence supporting physical activity for older adults is positive. We outline which activity types are most effective in different populations and settings.

ObjectivesTo establish normative reference values for work ability in healthy Australian adults using the Work Ability Score and investigate the association of physical performance factors.MethodsThe Work Ability Score was collected from 720 participants aged 18–101 years from the 1000 Norms Project. Physical performance was evaluated by assessing isometric strength of 13 muscle groups; flexibility of six joints; and 11 functional measures categorised as gross motor, fine motor and balance tasks. Correlations and multiple regression analyses were performed to identify physical performance factors independently associated with work ability.ResultsAge-stratified reference values were generated for work ability. Work ability increased during young adulthood (18–44 years) and declined from middle adulthood (45–64 years) into older adulthood (≥65 years), with no sex differences. Greater gross motor function and balance correlated with work ability (r=−0.498 to −0.285; p2=0.333, pConclusionsReference data can be used to identify individuals with low work ability. This study has identified physical factors associated with work ability that can potentially be targeted to maintain longevity in work. Physical tests such as the timed up and down stairs test may assist in the development of objective job-specific screening tools to assess work ability, supplementing subjective evaluation.

Background Pedobarography software calculates the centre-of-pressure trajectory in relation to the foot to quantify foot contact patterns. This study presents two new pedobarography measures using the centre-of-pressure trajectory to assess heel rocker. Methods To validate these pedobarography measures against 3D gait analysis, emed®-x and Vicon Nexus gait analysis data were captured from 25 children aged 8–16 years (11 male) with unilateral (n = 18) and bilateral (n = 7) cerebral palsy or acquired brain injury. 3D gait analysis identified whether heel rocker was intact (n = 22 feet) or absent (n = 28 feet) based on centre-of-pressure at initial contact and the ankle kinematic curve between 0 and 2% of the gait cycle. Pedobarography measures calculated from the initial centre-of-pressure point were the distance to the heel (point of initial contact) and to the most posterior point of the trajectory (rollback), reported as a percentage of foot length. Findings The median point of initial contact in limbs with an intact heel rocker was 9% (range 7–12%) and median rollback was 0% (range 0–0.2%), whereas the median point of initial contact in limbs with an absent heel rocker was 58% (range 8–78%) and rollback was 18% (range 0–40%). Point of initial contact is the more accurate method for predicting heel rocker, with a threshold of 14% of foot length identifying the correct heel rocker status in 94% of cases. Interpretation Point of initial contact can assess heel rocker with high accuracy. Both point of initial contact and rollback provide sensitive information on foot strike pattern, enhancing the utility of pedobarography.

Prostacyclin mimetics express potent vasoactive effects via prostanoid receptors that are not unequivocally defined, as to date no study has considered sex as a factor. The aim of this study was to determine the contribution of IP and EPWithin second-order mesenteric arteries from male and female Wistar rats, we determined (1) relative mRNA transcripts for EPIloprost evoked a biphasic response in male mesenteric arteries, at concentrations ≤100 nmol·LStark sexual dimorphisms in iloprost-mediated vasoactive responses are present within mesenteric arteries. K

Hypertension is a major cause of cardiovascular morbidity and mortality, despite the availability of antihypertensive drugs with different targets and mechanisms of action. Here, we provide evidence that pharmacological inhibition of TMEM16A (ANO1), a calcium-activated chloride channel expressed in vascular smooth muscle cells, blocks calcium-activated chloride currents and contraction in vascular smooth muscle invitro and decreases blood pressure in spontaneously hypertensive rats. The acylaminocycloalkylthiophene TMinh-23 fully inhibited calcium-activated TMEM16A chloride current with nanomolar potency in Fischer rat thyroid cells expressing TMEM16A, and in primary cultures of rat vascular smooth muscle cells. TMinh-23 reduced vasoconstriction caused by the thromboxane mimetic U46619 in mesenteric resistance arteries of wild-type and spontaneously hypertensive rats, with a greater inhibition in spontaneously hypertensive rats. Blood pressure measurements by tail-cuff and telemetry showed up to a 45-mmHg reduction in systolic blood pressure lasting for four-six hours in spontaneously hypertensive rats after a single dose of TMinh-23. A minimal effect on blood pressure was seen in wild-type rats or mice treated with TMinh-23. Five-day twice daily treatment of spontaneously hypertensive rats with TMinh-23 produced sustained reductions of 20-25 mmHg in daily mean systolic and diastolic blood pressure. TMinh-23 action was reversible, with blood pressure returning to baseline in spontaneously hypertensive rats by three days after treatment discontinuation. Thus, our studies provide validation for TMEM16A as a target for antihypertensive therapy and demonstrate the efficacy of TMinh-23 as an antihypertensive with a novel mechanism of action.

To investigate associations between eating behavior constructs (social eating, perceived competence, habit automaticity, self-determined motivation) and diet quality among young adults.Cross-sectional analysis.Young adults (n = 1,005; mean age, 21.7 ± 2.0 years; 85% female) enrolled in the Advice, Ideas, and Motivation for My Eating (Aim4Me) study.Four eating behavior measures collected via online surveys: Social Eating Scale, Perceived Competence in Healthy Eating Scale, Self-Report Behavioral Automaticity Index, and Regulation of Eating Behaviors scales. Diet quality was assessed using the Australian Recommended Food Score (ARFS) and percentage energy from energy-dense, nutrient-poor (EDNP) foods.Multivariate linear regression investigating associations between eating behavior measures (independent variables) and ARFS and EDNP foods (dependent variables), adjusting for sociodemographic and lifestyle confounders.Greater perceived competence in healthy eating and behavioral automaticity for consuming healthy foods, limiting EDNP food intake, and higher intrinsic motivation, integrated regulation, and identified regulation of eating behaviors were associated with higher ARFS and lower percentage energy EDNP foods (P0.001). Greater self-reported social influence on eating behaviors was associated with higher ARFS (P = 0.01). Higher amotivation was associated with greater % energy from EDNP foods (P0.001).Perceived competence, habit automaticity, and self-determined motivation are determinants of diet quality in young adults. These findings support the development of interventions that promote healthy eating habits by focusing on eating behavior constructs and evaluating their use in improving diet quality.

Reduced muscle tone, muscle weakness, and physical fatigue can impact considerably on quality of life for children with neurofibromatosis type 1 (NF1). Human muscle biopsies and mouse models of NF1 deficiency in muscle show intramyocellular lipid accumulation, and preclinical data have indicated that L-carnitine supplementation can ameliorate this phenotype. The aim of this study is to examine whether daily L-carnitine supplementation is safe and feasible, and will improve muscle strength and reduce fatigue in children with NF1. A 12-week Phase 2a trial was conducted using 1000 mg daily oral levocarnitine tartrate supplementation. Recruited children were between 8 and 12 years old with a clinical diagnosis of NF1, history of muscle weakness and fatigue, and naive to L-carnitine. Primary outcomes were safety (self-reporting, biochemical testing) and compliance. Secondary outcomes included plasma acylcarnitine profiles, functional measures (muscle strength, long jump, handwriting speed, 6-minute-walk test [6MWT]), and parent-reported questionnaires (PedsQL™, CBCL/6-18). Six children completed the trial with no self-reported adverse events. Biochemical tests for kidney and liver function were normal, and the average compliance was 95%. Plasma acylcarnitine levels were low, but within a range not clinically linked to carnitine deficiency. For strength measures, there was a mean 53% increase in dorsiflexion strength (95% confidence interval [CI] 8.89-60.75; p = 0.02) and mean 66% increase in plantarflexion strength (95% CI 12.99-134.1; p = 0.03). In terms of muscle performance, there was a mean 10% increase in long jump distance (95% CI 2.97-16.03; p = 0.01) and 6MWT distance (95% CI 5.88-75.45; p = 0.03). Comparison with the 1000 Norms Project data showed a significant improvement in Z-score for all of these measures. Parent reports showed no negative impact on quality of life, and the perceived benefits led to the majority of individuals remaining on L-carnitine after the study. Twelve weeks of L-carnitine supplementation is safe and feasible in children with NF1, and a Phase 3 trial should confirm the efficacy of treatment.

INTRODUCTION/AIMS: We aim to describe 12-month functional and motor outcome performance in a cohort of participants with congenital myotonic dystrophy (CDM). METHODS: CDM participants performed the Six Minute Walk Test (6MWT), 10 Meter Run, 4 Stair Climb, Grip Strength and Lip Force at baseline and 12 month visits. Parents completed the Vineland Adaptive Behavior Scale. RESULTS: Forty-seven participants, aged 0 to 13 years old, with CDM were enrolled. 6MWT, 10 Meter Run and 4 Stair Climb were completed in >85% of eligible participants. The only significant difference between mean baseline and 12-month performance was an improvement in 6MWT in children 3–6 years old (p=0.008). This age group also had the largest mean % improvement in performance in all other timed functional testing. In children >7 years, the slope of change on timed functional tests decreased or plateaued, with further reductions in performance in children ≥10 years. Participants with CTG repeat lengths 1000. DISCUSSION: 6MWT, 10 Meter Run and 4 Stair Climb were the most feasible measures. Our findings are consistent with the clinical profile and prior cross-sectional data, helping to establish reasonable expectations of functional trajectories in this population as well as identifying points in which therapeutic interventions may be best studied. Further study of outcomes in children >10 years old and

To discuss and understand urban teaching and Black girls’ pedagogies, the fundamental premise is that Black girls are not monolithic, but complex and nonhomogenous. Black girlhood studies recognize that, because of their intersectional race, class, and gender status, Black girls have different experiences than Black boys and White girls. Core themes in Black girlhood include self-identity and socialization; beauty and self-expression; popular culture, hip hop, and stereotypes; violence; systemic discipline in schools; and resiliency and survival. Responding to the unique experiences of Black girls, Black women educators developed and adopted a pedagogy that focuses on and centers Black girls and Black girlhood in all their complexity. Using a strengths-based approach, Black girls’ pedagogy is built on a Black feminist and womanist framework that recognizes the need for culturally informed curriculum and classroom experiences, more Black women educators, and a commitment to an ethics of care.

Hypertension is a major cause of cardiovascular morbidity and mortality, despite the availability of antihypertensive drugs with different targets and mechanisms of action. There is an unmet need for antihypertensive drugs with novel mechanisms of action to better control hypertension and reduce cardiovascular morbidity and mortality. Here, we provide evidence that pharmacological inhibition of TMEM16A (transmembrane member 16A or anoctamin-1), a Ca 2+ -activated Cl - channel expressed in vascular smooth muscle cells, reduces in vitro vascular smooth muscle contraction and decreases blood pressure in spontaneously hypertensive rats (SHR). We recently identified by high-throughput screening and subsequent medicinal chemistry, small molecule TMEM16A inhibitor TM inh -23 (2-bromodifluoroacetylamino-5,6,7,8-tetrahydro-4H-cyclohepta[b]thiophene-3-carboxylic acid o-tolylamide) that inhibits TMEM16A current fully, with IC 50 ~ 30 nM. TM inh -23 pretreatment blocked maximum in vitro vascular smooth muscle contractions induced by a thromboxane mimetic (U46619) in rat mesenteric arteries by 90%. Intraperitoneal (ip) administration of TM inh -23 to rodents at 10 mg/kg produced sustained serum concentrations of >10 μM for >4 hours. BP measurements by tail-cuff and telemetry showed a maximum ~45 mmHg reduction in SBP in spontaneously hypertensive rats (SHR) after a single dose (10 mg/kg, ip) TM inh -23 administration compared to vehicle treatment, with BP gradually returning to baseline values within 6-8 hours after TM inh -23 treatment. Minimal effect on BP (less than 10 mmHg decrease in SBP) was seen in wild-type rats and mice with TM inh -23 treatment (10 mg/kg, ip). Chronic 5-day treatment of SHR with TM inh -23 (10 mg/kg, ip, twice daily) caused sustained decreases (~20-25 mmHg) in daily average SBP, DBP and MAP during the treatment period. TM inh -23 action was reversible, with BP returning to baseline (~170/115 mmHg) by 3 days after discontinuation of treatment. These studies provide validation for TMEM16A as a target for antihypertensive therapy, and demonstrate the proof-of-concept for efficacy of TM inh -23 as an antihypertensive with a novel mechanism of action.

Background and Purpose: Arterial diameter is dictated by the contractile state of the vascular smooth muscle cells (VSMCs), which is modulated by direct and indirect inputs from endothelial cells (ECs). Modulators of KCNQ-encoded kV7 channels have considerable impact on arterial diameter and these channels are known to be expressed in VSMCs but not yet defined in ECs. However, expression of kV7 channels in ECs would add an extra level of vascular control. This study aims to characterize the expression and function of KV7 channels within rat mesenteric artery ECs. Experimental Approach: In rat mesenteric artery, KCNQ transcript and KV7 channel protein expression were determined via RT-qPCR, immunocytochemistry, immunohistochemistry and immunoelectron microscopy. Wire myography was used to determine vascular reactivity. Key Results: KCNQ transcript was identified in isolated ECs and VSMCs. KV7.1, KV7.4 and KV7.5 protein expression was determined in both isolated EC and VSMC and in whole vessels. Removal of ECs attenuated vasorelaxation to two structurally different KV7.2-5 activators S-1 and ML213. KIR2 blockers ML133, and BaCl2 also attenuated S-1 or ML213-mediated vasorelaxation in an endothelium-dependent process. KV7 inhibition attenuated receptor-dependent nitric oxide (NO)-mediated vasorelaxation to carbachol, but had no impact on relaxation to the NO donor, SNP. Conclusion and Implications: In rat mesenteric artery ECs, KV7.4 and KV7.5 channels are expressed, functionally interact with endothelial KIR2.x channels and contribute to endogenous eNOS-mediated relaxation. This study identifies KV7 channels as novel functional channels within rat mesenteric ECs and suggests that these channels are involved in NO release from the endothelium of these vessels.

Background and purpose KCNQ-encoded KV7 channels are expressed within vascular smooth muscle cells (VSMCs) and are key regulators of vascular reactivity, regulating resting tone and as functional targets of endogenous responses. Endothelial cells (ECs) form a paracrine signaling platform that line all blood vessels and regulate tone, but little is known of KV7 channels in vascular ECs. This study aims to characterize the expression and function of KV7 channels within rat mesenteric artery ECs. Experimental approach In rat mesenteric artery, KCNQ transcript and KV7 channel protein expression were determined via RT-qPCR, immunocytochemistry, immunohistochemistry and immunoelectron microscopy. Wire myography was used to determine vascular reactivity. Key results KCNQ transcript was identified in EC marker expressing cells using a reductive approach. KV7.4 and KV7.5 protein expression was determined in both isolated EC and VSMC and in whole vessels. Removal of ECs attenuated vasorelaxation to two structurally different KV7.2-5 activators S-1 and ML213. KIR2 blockers ML133 and BaCl also attenuated S-1 or ML213-mediated vasorelaxation in an endothelium-dependent process. KV7 inhibition attenuated receptor-dependent nitric oxide (NO)-mediated vasorelaxation to carbachol, but had no impact on relaxation to the NO donor, SNP. Conclusions and implications In rat mesenteric artery ECs, KV7.4 and KV7.5 channels are expressed, functionally interact with endothelial KIR2.x channels and contribute to endogenous eNOS-mediated relaxation. This study identifies KV7 channels as novel functional channels within rat mesenteric ECs and suggests that these channels are involved in NO release from the endothelium.

The primary aim was to determine the association between sagittal cervical mobility and the presence and extent of GJH across the lifespan. Secondary aims were to determine which features explain variability in cervical range of motion (CROM) and to establish the sagittal cervical hypermobile range in both genders across the lifespan.Cross-sectional observational study. Spearman's rho determined the relationship between presence and extent of GJH and CROM, age, gender and ethnicity. Multiple regression identified the factors explaining variability in CROM. The hypermobile CROM was identified as the upper 5% of flexion, extension and combined ranges for age and gender.University laboratory in Sydney Australia.One thousand healthy individuals, aged 3-101 years.Cervical active range of motion was assessed using an inclinometer, extent of and presence of generalised joint hypermobility were assessed using the Beighton scoring system and age- and gender-specific criteria respectively.CROM correlated positively with GJH (Beighton score as a continuous or dichotomous age and gender specific variable) (rho=0.12-0.50; p 0.001) and negatively with age (rho=0.54; p 0.001). Age, gender and extent of GJH (Beighton as a continuous score) accounted for 19 to 51% of variability in CROM. Cut-offs for cervical hypermobility were calculated across the lifespan.Increased sagittal CROM was observed in individuals identified with GJH. Extension CROM decreased with age more than flexion; the greatest loss in the second and third decades. CROM screening is warranted for patients identified with GJH and for rehabilitation goal-setting.

The high-rise residential buildings of China will soon need retrofitting and any such retrofitting should include consideration of new energy saving methods and ‘green’ technologies. A research agenda is needed to meet this challenge. This paper presents a research agenda for the ‘green’ retrofitting of residential buildings. The agenda is based on the input of 25 national and international experts which was produced by a novel methodology specifically designed to discuss the key questions relating to the retrofitting of residential buildings. This methodology, based on Problem Tree Analysis, proved an effective method of producing an agenda for the research that is needed to facilitate such change. The research needs are presented under six headings. Stages for undertaking the research activities under each of these headings have been identified. The agenda highlights that the challenge of retrofitting is holistic and includes not just engineering and construction actions but economic, social and governmental requirements. Key aspects of the research agenda include the need for better macro-economic and micro-economic models and a better understanding of people's needs and expectations. These topics are discussed together with recent research findings both from China and other countries.

Air travel has become the most popular form of long distance travel owing to speed and convenience. In order to create a healthy and thermally comfortable environment in the aircraft's cabin, personalized nozzle ventilation is supplied to passengers. In such a system, the temperature of the supplied air is normally lower than the ambient temperature by 5 °C. In this study, an experimental investigation of thermal responses and skin temperature measurements was carried out in a mock-up of an aircraft cabin. The results indicate that local cooling is an effective way to improve the overall thermal comfort, especially for cooling the upper body. Based on paired t -test analyses, there were no significant temperature differences between the effects of isothermal and non-isothermal air supply on subjective responses and mean skin temperatures. The regression models of local thermal and overall thermal sensations were obtained and analyzed. Such models will be beneficial for the optimum design of future personalized nozzle ventilation systems.

Healthcare costs are lower for adults who consume more vegetables, however, the association between healthcare costs and fruit and vegetable varieties is unclear. Our aim was to investigate the association between (i) baseline fruit and vegetable (F&amp, V) varieties, and (ii) changes in F&amp, V varieties over time with 15-year healthcare costs in an Australian Longitudinal Study on Women’s Health. The data for Survey 3 (n = 8833 women, aged 50–55 years) and Survey 7 (n = 6955, aged 62–67 years) of the 1946–1951 cohort were used. The F&amp, V variety was assessed using the Fruit and Vegetable Variety (FAVVA) index calculated from the Cancer Council of Victoria’s Dietary Questionnaire for Epidemiological Studies food frequency questionnaire. The baseline FAVVA and change in FAVVA were analysed as continuous predictors of Medicare claims/costs by using multiple regression analyses. Healthy weight women made, on average, 4.3 (95% confidence interval (CI) 1.7–6.8) fewer claims for every 10-point-higher FAVVA. Healthy weight women with higher fruit varieties incurred fewer charges, however, this was reversed for women overweight/obese. Across the sample, for every 10-point increase in FAVVA over time, women made 4.3 (95% CI 1.9–6.8) fewer claims and incurred $309.1 (95% CI $129.3–488.8) less in charges over 15 years. A higher F&amp, V variety is associated with a small reduction in healthcare claims for healthy weight women only. An increasing F&amp, V variety over time is associated with lower healthcare costs.

Purpose The purpose of this paper is to present a detailed case study on the methods and organisational structure used for controlling the time schedule for a large and complex project. The paper discusses the use of “project controlling”, a term used to describe project control by a third-party organisation. Design/methodology/approach The researchers used action research to collect data for the case study. A member of the research team was a “participant-observer” on the project on a day-to-day basis for a period of 18 months collecting and analysing data which were subsequently analysed by a mixed methods approach. Findings The use of a “Project Controlling Unit” operated by an independent adviser organisation has significant advantages over traditional methods. It can provide timely, consolidated, independent guidance to the client and assistance to other participating organisations. Research limitations/implications The research has confirmed the effectiveness of the method on the project under study. Practical implications The findings provide guidance for enhanced project control on large complex infrastructural projects that will be of interest to other researchers, other clients and other construction organisations both within China and internationally. Social implications Organisations that seek to develop Project Controlling Units to implement the methods described in this paper will need to review their recruitment and training strategies to ensure that appropriate and experienced staffs are engaged. Originality/value The paper extends the knowledge relating to “project controlling” method. The findings provide additional insights to progress reporting and the management of construction production on HOPSCA and other large infrastructural projects.

In order to understand passengers’ demand for thermal comfort in aircraft cabins, we carried out a measurement of thermal environment parameters and thermal comfort field survey in an aircraft cabin under cruising at altitude in both summer and winter. The results showed that the air temperature studied was always kept within the range of 25℃ to 28℃ and the relative humidity was maintained within the range of 20% to 35%. The Mean Thermal Sensation Vote (MTSV) of passengers’ back and feet was higher than other local body parts, with lower air movement sensation. The MTSV of passengers in winter was higher than that in summer. Due to the muggy thermal environment, more than 60% of passengers advocated that it was necessary to utilize the personal ventilation system. In their usage of the personal ventilation nozzle, more than half of these passengers chose to cool upper body parts, only a minimum number of passengers opened the nozzle to direct airflow to their head. Therefore, we concluded that the position of the personal ventilation nozzle should be as close to the upper body part of a passenger’s body as possible, making it more convenient and effective to regulate passengers’ thermal comfort.

Objective The purpose of this study was to establish normative reference values for spatiotemporal and plantar pressure parameters, and to investigate the influence of demographic, anthropometric and physical characteristics. Methods In 1000 healthy males and females aged 3–101 years, spatiotemporal and plantar pressure data were collected barefoot with the Zeno™ walkway and Emed® platform. Correlograms were developed to visualise the relationships between widely reported spatiotemporal and pressure variables with demographic (age, gender), anthropometric (height, mass, waist circumference) and physical characteristics (ankle strength, ankle range of motion, vibration perception) in children aged 3–9 years, adolescents aged 10–19 years, adults aged 20–59 years and older adults aged over 60 years. Results A comprehensive catalogue of 31 spatiotemporal and pressure variables were generated from 1000 healthy individuals. The key findings were that gait velocity was stable during adolescence and adulthood, while children and older adults walked at a comparable slower speed. Peak pressures increased during childhood to older adulthood. Children demonstrated highest peak pressures beneath the rearfoot whilst adolescents, adults and older adults demonstrated highest pressures at the forefoot. Main factors influencing spatiotemporal and pressure parameters were: increased age, height, body mass and waist circumference, as well as ankle dorsiflexion and plantarflexion strength. Conclusion This study has established whole of life normative reference values of widely used spatiotemporal and plantar pressure parameters, and revealed changes to be expected across the lifespan.

Objectives The primary aim of this study was to evaluate generalized joint hypermobility (GJH) according to the Beighton scoring system in an Australian population. Secondary aims were to identify whether the commonly used Beighton score cut-off of ⩾4 is appropriate, and to suggest age- and sex-specific Beighton score cut-offs across the lifespan. Methods A thousand individuals aged 3-101 years were assessed for GJH with the Beighton scoring system. Differences between age, sex and ethnicity were investigated. The appropriateness of the ⩾4 cut-off was investigated with use of a binary logistic regression. Each Beighton score cut-off was established as the nearest Beighton score that delineated the uppermost 5% of the population. Results Overall, females and non-Caucasians had higher Beighton scores across the lifespan (P < 0.001). Based on a binary logistic regression model, if a cut-off of ⩾4 was utilized, the Beighton scoring system demonstrated a sensitivity of 0.8% and a specificity of 99.3% (P < 0.001). A cut-off of ⩾4 was only found to be appropriate for females aged 40-59 years and males aged 8-39 years. Conclusion Beighton scores varied across the lifespan and were significantly influenced by age, sex and ethnicity. Assessing GJH using the Beighton scoring system required age- and sex-specific cut-off scores based on the uppermost 5% values. This was confirmed by the low sensitivity, high specificity and 60% false-positive rate if a cut-off of ⩾4 was used for both sexes across the lifespan. To lower the risk of a false-positive diagnosis of GJH, further tests of hypermobility need to be utilized.

Objectives To provide reference data for the Cumberland Ankle Instability Tool (CAIT) and to investigate the prevalence and correlates of perceived ankle instability in a large healthy population. Design Cross-sectional observational study. Setting University laboratory. Participants Self-reported healthy individuals (N=900; age range, 8–101y, stratified by age and sex) from the 1000 Norms Project. Interventions Not applicable. Main Outcome Measures Participants completed the CAIT (age range, 18–101y) or CAIT-Youth (age range, 8–17y). Sociodemographic factors, anthropometric measures, hypermobility, foot alignment, toes strength, lower limb alignment, and ankle strength and range of motion were analyzed. Results Of the 900 individuals aged 8 to 101 years, 203 (23%) had bilateral and 73 (8%) had unilateral perceived ankle instability. The odds of bilateral ankle instability were 2.6 (95% confidence interval [CI], 1.7–3.8; P P =.001) for each year of increasing age, increased by 3% (95% CI, 0%–6%; P =.041) for each degree of ankle dorsiflexion tightness, and increased by 4% (95% CI, 2%–6%, P Conclusions Perceived ankle instability was common, with almost a quarter of the sample reporting bilateral instability. Female sex, younger age, increased abdominal adiposity, and decreased ankle dorsiflexion range of motion were independently associated with perceived ankle instability.

Understanding patterns of dietary change over time can provide important information regarding population nutrition behaviours. The aims were to investigate change in diet quality over 12 years in a nationally representative sample of women born in 1946&ndash, 1951 and to identify characteristics of women whose diet quality changed over time. The Australian Recommended Food Score (ARFS) was measured in 2001 (n = 10,629, mean age 52.1 years) and 2013 (n = 9115, n = 8161 for both time points) for the mid-aged cohort from the Australian Longitudinal Study on Women&rsquo, s Health. Participants were categorised by tertiles of baseline diet quality and also classified as &lsquo, diet quality worsened&rsquo, (ARFS decrease &le, &minus, 4 points, n = 2361), &lsquo, remained stable&rsquo, (&minus, 3 &le, change in ARFS &le, 3 points, n = 3077) or &lsquo, improved&rsquo, (ARFS increase &ge, 4 points, n = 2723). On average, ARFS total and subscale scores remained relatively stable over time (mean [SD] change 0.3 [7.6] points) with some regression to the mean. Women whose diet quality worsened were more likely to be highly physically active at baseline compared with women whose diet quality improved (p &lt, 0.001). Among women with poor diet quality initially (lowest baseline ARFS tertile, n = 2451, mean [SD] baseline ARFS 22.8 [4.5] points), almost half (47%, n = 1148) had not improved after 12 years, with women less likely to be in the healthy weight range (41% compared to 44%) and be never smokers (56% versus 62%, p &lt, 0.05) compared with those whose diet improved. Diet quality remained relatively stable over 12 years&rsquo, follow up among mid-aged women. Almost half of those with poor baseline diet quality remained poor over time, emphasizing the need to target high-risk groups for nutrition interventions.

Osteoarthritis is a prevalent and costly condition. Knowledge of the quality of care being offered to people with hip and knee osteoarthritis in New Zealand is limited. The aim of this study was to investigate the quality of care being offered to people with hip and knee osteoarthritis in New Zealand, and to investigate common pathways of care. The OsteoArthritis Quality Indicator (osteoarthritis) questionnaire was administered to adults with hip and/or knee osteoarthritis, and participants were also asked to list the healthcare professionals they had consulted. Descriptive statistics with 95% confidence intervals were calculated. The study included 106 participants (87% female, n = 92; 94% European, n = 100). The mean OsteoArthritis Quality Indicator achievement rate was 50.2% (95% confidence intervals 41.0–59.7%). OsteoArthritis Quality Indicator achievement rates were lowest for weight reduction referral (8.6%; 3.7–17.8%) and daily activity aids assessment (18.5%; 10.2–31.0%), and highest for physical activity education (80.8%; 72.1–87.3%) and offering of paracetamol (80.0%; 71.3–86.6%). Following consultation with a general practitioner, 22% (n = 24) consulted orthopaedic surgeons while 15% (n = 17) consulted physiotherapists. The results suggest that implementation of evidence informed conservative treatments for osteoarthritis in primary care is suboptimal, although evidence from a larger representative sample is needed.

To examine socio-demographic trends in doctor and nurse utilisation rates for invoiced consultations across Comprehensive Care Primary Health Organisation (PHO).De-identified enrolled patient information and Service Utilisation Reporting data for invoiced consultations were extracted from all general practices for January 2013-December 2016. Utilisation rates were calculated using the number of enrolled patients as the denominator.Data for 3,657,873 invoiced consultations across 66 general practices were analysed, including 2,941,624 doctor and 716,249 nurse consultations. Average utilisation rates were 3.1 visits per patient year for doctors and 0.7 visits for nurses, with considerable variability between practices. Utilisation rates were higher for females (3.3 visits for doctors; 0.8 for nurses), older adults (5.0-6.9; 1.3-1.6 visits) and patients residing in the most socially deprived quintile (3.3; 1.6 visits). European patients had the highest doctor utilisation rates (3.2 visits), while Māori and Pacific patients had the highest nurse utilisation rates (1.1 and 1.3 visits, respectively).Females, older adults and people residing in socially deprived areas utilise primary care more frequently according to invoiced consultation data. Analysis of all other consultations, including immunisations, Accident Corporation Claims and non-billed services is needed to more accurately capture utilisation rates, particularly for nurses, to better inform national decision-making, workforce planning and funding assumptions.