Search

Background: Dementia prevention is a global health priority, and there is emerging evidence to support associations between individual modifiable health behaviors and cognitive function and dementia risk. However, a key property of these behaviors is they often co-occur or cluster, highlighting the importance of examining them in combination. Objective: To identify and characterize the statistical approaches used to aggregate multiple health-related behaviors/modifiable risk factors and assess associations with cognitive outcomes in adults. Methods: Eight electronic databases were searched to identify observational studies exploring the association between two or more aggregated health-related behaviors and cognitive outcomes in adults. Results: Sixty-two articles were included in this review. Fifty articles employed co-occurrence approaches alone to aggregate health behaviors/other modifiable risk factors, eight studies used solely clustering-based approaches, and four studies used a combination of both. Co-occurrence methods include additive index-based approaches and presenting specific health combinations, and whilst simple to construct and interpret, do not consider the underlying associations between co-occurring behaviors/risk factors. Clustering-based approaches do focus on underlying associations, and further work in this area may aid in identifying at-risk subgroups and understanding specific combinations of health-related behaviors/risk factors of particular importance in the scope of cognitive function and neurocognitive decline. Conclusion: A co-occurrence approach to aggregating health-related behaviors/risk factors and exploring associations with adult cognitive outcomes has been the predominant statistical approach used to date, with a lack of research employing more advanced statistical methods to explore clustering-based approaches.

Objectives: Alcohol is the most widely consumed psychoactive substance in Australia and the consequences of alcohol consumption have enormous personal and social impacts. This study aimed to describe the principal diagnoses of emergency department (ED) presentations involving alcohol use in the previous 12 hours at eight hospitals in Victoria and the Australian Capital Territory, Australia. Methods: Twelve months’ data (1 July 2018 – 30 June 2019) were collected from eight EDs, including demographics, ICD‐10 codes, hospital location and self‐reported drinking in the preceding 12 hours. The ten most common ICD‐10 discharge codes were analysed based on age, sex and hospital geographic area. Results: ICD codes pertaining to mental and behavioural disorders due to alcohol use accounted for the highest proportion in most EDs. Suicide ideation/attempt was in the five highest ICD codes for all but one hospital. It was the second most common alcohol‐related presentation for both males and females. Conclusions: Alcohol plays a major role in a range of presentations, especially in relation to mental health and suicide. Implications for public health: The collection of alcohol involvement in ED presentations represents a major step forward in informing the community about the burden of alcohol on their health resources.

Diet and genetic predisposition to adiposity are independent predictors of body composition, yet few cohort studies have examined the association between overall diet quality indices, genetic risk and body composition. This study examined the prospective association of three diet quality indices and a polygenic risk score (PRS) with trunk fat mass, total fat mass, lean mass and bone mineral content.Adults from UK Biobank cohort were included. Dietary intake was assessed using the Oxford WebQ and three diet quality indices calculated: Recommended Food Score (RFS); Mediterranean Diet Score (MDS); Healthy Diet Indicator (HDI). Bioimpedance data were available for trunk fat, total fat and lean mass (kg). Trunk fat mass (kg), total fat mass (kg) and lean mass (kg) were assessed using bioelectrical impedance (BIA) in 17,478 adults. Bone mineral content (g) was available from dual energy x-ray absorptiometry (DXA) scans in 11,887 participants. Linear regression analyses, adjusted for demographic and lifestyle confounders, were used to estimate prospective associations between each diet quality index and body composition outcomes. A PRS created from 97 adiposity-related single nucleotide polymorphisms was used to examine interaction effects.A total of 17,478 adults (M = 55.9, SD 7.5 years) were followed up for up to 10 years. RFS, HDI and MDS were inversely associated with trunk fat (RFS: B -0.29; 95% CI: -0.33, -0.25; HDI: -0.23; -0.27, -0.19; MDS: -0.22; -0.26, -0.18), total fat (RFS: B -0.49; 95% CI: -0.56, -0.42; HDI: -0.38; -0.45, -0.32; MDS: -0.38; -0.44, -0.32) and lean (RFS: B -0.10; 95% CI: -0.14, -0.06; HDI: -0.07; -0.11, -0.03; MDS: -0.07; -0.11, -0.04) mass. Diet quality was positively associated with bone mineral content (RFS: B 8.23; 95% CI: 2.14, 14.3; HDI: 6.77; 1.00, 12.5). There was evidence of non-linear associations between diet quality (RFS and HDI only) and trunk fat (p 0.01) and total fat mass (p 0.05). There was limited evidence PRS was associated with body composition, with interaction effects of PRS and HDI (p-interaction = 0.039) and MDS (p-interaction = 0.031) on total fat mass.Higher diet quality was associated with lower trunk fat, total fat and lean mass, regardless of the diet quality index examined (RFS, HDI or MDS), while higher diet quality (RFS and HDI only) was associated with higher bone mineral content. The benefit of higher diet quality on reducing total fat mass was most evident in individuals with higher generic risk of adiposity. These findings underscore the importance of a high-quality diet for maintaining optimal body composition, particularly in individuals with genetic pre-disposition to adiposity.

Background Heat adaptation regimes are used to prepare athletes for exercise in hot conditions to limit a decrement in exercise performance. However, the heat adaptation literature mostly focuses on males, and consequently, current heat adaptation guidelines may not be optimal for females when accounting for the biological and phenotypical differences between sexes. Objectives We aimed to examine: (1) the effects of heat adaptation on physiological adaptations in females; (2) the impact of heat adaptation on performance test outcomes in the heat; and (3) the impact of various moderators, including duration (minutes and/or days), total heat dose (°C.min), exercise intensity (kcal.min−1), total energy expended (kcal), frequency of heat exposures and training status on the physiological adaptations in the heat. Methods SPORTDiscus, MEDLINE Complete and Embase databases were searched to December 2022. Random-effects meta-analyses for resting and exercise core temperature, skin temperature, heart rate, sweat rate, plasma volume and performance tests in the heat were completed using Stata Statistical Software: Release 17. Sub-group meta-analyses were performed to explore the effect of duration, total heat dose, exercise intensity, total energy expended, frequency of heat exposure and training status on resting and exercise core temperature, skin temperature, heart rate and sweat rate. An explorative meta-regression was conducted to determine the effects of physiological adaptations on performance test outcomes in the heat following heat adaptation. Results Thirty studies were included in the systematic review; 22 studies were meta-analysed. After heat adaptation, a reduction in resting core temperature (effect size [ES] = − 0.45; 95% confidence interval [CI] − 0.69, − 0.22; p p p p p = 0.001) were identified in females. There was no change in plasma volume (ES = − 0.03; 95% CI − 0.31, 0.25; p = 0.835), whilst performance test outcomes were improved following heat adaptation (ES = 1.00; 95% CI 0.56, 1.45; p .min−1, total energy expended ≥ 3038 kcal, consecutive (daily) frequency and total heat dose ≥ 23,000 °C.min. The magnitude of change in performance test outcomes in the heat was associated with a reduction in heart rate following heat adaptation (standardised mean difference = − 10 beats.min−1; 95% CI − 19, − 1; p = 0.031). Conclusions Heat adaptation regimes induce physiological adaptations beneficial to thermoregulation and performance test outcomes in the heat in females. Sport coaches and applied sport practitioners can utilise the framework developed in this review to design and implement heat adaptation strategies for females.

Atypical motor coordination and cognitive processes, such as response inhibition and working memory, have been extensively researched in individuals with attention deficit hyperactivity disorder (ADHD). Oculomotor neural circuits overlap extensively with regions involved in motor planning and cognition, therefore studies of oculomotor function may offer unique insights into motor and cognitive control in ADHD. We performed a series of pairwise meta-analyses based on data from 26 oculomotor studies in ADHD to examine whether there were differences in performance on visually-guided saccade, gap, antisaccade, memory-guided, pursuit eye movements and fixation tasks. These analyses revealed oculomotor disturbances in ADHD, particularly for difficulties relating to saccade inhibition, memorizing visual target locations and initiating antisaccades. There was no evidence for pursuit eye movement disturbances or saccade dysmetria. Investigating oculomotor abnormalities in ADHD may provide insight into top-down cognitive control processes and motor control, and may serve as a promising biomarker in ADHD research and clinical practice.

Inaccurate medication documentation in prescriptions and discharge summaries produce poorer patient outcomes, are costly to healthcare systems and result in more readmissions to hospital. Errors in medication documentation are common in Australian hospitals.To determine if pharmacist-led partnered prescribing (PPP) on discharge reduced errors and improved accuracy in documentation of medications in the discharge prescription and the discharge summary of people with kidney disease compared with medical prescribing (MP).This interventional 2-phase study compared current workflow (MP) with the subsequent implementation of the interventional workflow (PPP) in the renal unit of a tertiary referral hospital. Patients were included if they were discharged within pharmacy working hours and had a discharge prescription and discharge summary. The primary outcome was the percentage of discharge prescriptions with at least one error. The secondary outcome was the percentage of discharge summaries with at least one error.Data was collected from 185 discharged patients (95 in MP phase then 90 in PPP phase). Discharge prescriptions with at least one error reduced from 75.8% in the MP phase to 6.7% in PPP phase (P0.001). Discharge summaries with at least one error reduced from 53% in MP phase to 24% in the PPP phase (P0.001).Pharmacist-led partnered prescribing improves the accuracy of the documentation of medications in both the discharge prescription and the discharge summary of patients with kidney disease. This article is protected by copyright. All rights reserved.

Background Mounting evidence highlights the importance of combined modifiable lifestyle factors in reducing risk of cognitive decline and dementia. Several a priori additive scoring approaches have been established; however, limited research has employed advanced data-driven approaches to explore this association. This study aimed to examine the association between data-driven lifestyle profiles and cognitive function in community-dwelling Australian adults. Methods A cross-sectional study of 4561 Australian adults (55.3% female, mean age 60.9 ± 11.3 years) was conducted. Questionnaires were used to collect self-reported data on diet, physical activity, sedentary time, smoking status, and alcohol consumption. Cognitive testing was undertaken to assess memory, processing speed, and vocabulary and verbal knowledge. Latent Profile Analysis (LPA) was conducted to identify subgroups characterised by similar patterns of lifestyle behaviours. The resultant subgroups, or profiles, were then used to further explore associations with cognitive function using linear regression models and an automatic Bolck, Croon & Hagenaars (BCH) approach. Results Three profiles were identified: (1) “Inactive, poor diet” (76.3%); (2) “Moderate activity, non-smokers” (18.7%); and (3) “Highly active, unhealthy drinkers” (5.0%). Profile 2 “Moderate activity, non-smokers” exhibited better processing speed than Profile 1 “Inactive, poor diet”. There was also some evidence to suggest Profile 3 “Highly active, unhealthy drinkers” exhibited poorer vocabulary and verbal knowledge compared to Profile 1 and poorer processing speed and memory scores compared to Profile 2. Conclusion In this population of community-dwelling Australian adults, a sub-group characterised by moderate activity levels and higher rates of non-smoking had better cognitive function compared to two other identified sub-groups. This study demonstrates how LPA can be used to highlight sub-groups of a population that may be at increased risk of dementia and benefit most from lifestyle-based multidomain intervention strategies.

Allostatic load is a model that is used to quantify the physiological damage from exposure to stressors. Stressful life events are chronic stressors that can lead to an elevated allostatic load through the physiological and behavioral stress responses. However, there is limited empirical studies that has tested the proposed behavioural pathway. Our study addresses this gap by examining the mediating role of combined modifiable lifestyle behaviors in the 12-years longitudinal association between stressful life events and allostatic load among participants from the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study cohort. A latent profile analysis was performed to identify latent subgroups with distinct behavioral clusters based on five modifiable lifestyle behaviors (smoking, sedentary behavior, physical activity, alcohol consumption, and diet quality). We then used a sequential mediation model design with path analysis to test the mediating effect of these latent subgroups in the associations between stressful life events and three measures of allostatic load. Indirect effects were estimated using the product of coefficient approach and the statistical significance was determined by the 95% bias-corrected bootstrap confidence intervals with 1000 replications. We identified three latent subgroups: "least healthy lifestyle" (12%; n = 396), "moderately healthy lifestyle" (78.7%; n = 2599), and "most healthy lifestyle" (9.2%; n = 306). Exposure to stressful life events was not associated with the allocation of participants in latent subgroups. Compared to the "moderately healthy lifestyle" subgroups, we found that the "least healthy lifestyle" behavioral cluster was not associated with allostatic load. However, there was a significant inverse association between the "most healthy lifestyle" behavioral cluster and allostatic load. Overall, we did not find significant indirect effects between stressful life events and three measures of allostatic load via the "least healthy lifestyle" and the "most healthy lifestyle" groups. In summary, the combinations of modifiable lifestyle behaviors did not explain the association between stressful life events and allostatic load. More longitudinal studies are needed to replicate our study to confirm this finding.

The aim of this study was to determine the validity and reliability of the Perceived Movement Skill Competence scales for Iranian children. In particular, the scales aligned with the second and third versions of the Test of Gross Motor Development and the active play skills. The total sample was 314 children aged 4–8 years (Mage = 6.1 years,SD = 1.1). From this, a random sample of 74 were recruited for face validity. The data from the remaining 240 children were used to establish construct validity using Bayesian Structural Equation Modeling. The data from a second random subsample of 126 children were used to investigate Perceived Movement Skill Competence reliability using ordinal alpha coefficients and intraclass correlations coefficients. The majority of children correctly identified the skills and understood most of the pictures. Internal consistency was very good (from 0.81 to 0.95) for all scales and subscales. Test–retest reliability was excellent with intraclass correlation coefficient values above .85. For construct validity, the initial hypothesized models for three-factor (i.e., locomotor, object control, and play skills) and two-factor (i.e., locomotor and object control) models showed a reasonable fit. The pictorial scales for Perceived Movement Skill Competence are valid and reliable for Iranian young children.

Background Staphylococcus aureus (S. aureus) bacteraemia is increasingly acquired from community settings and is associated with a mortality rate of up to 40% following complications. Identifying risk factors for complicated S. aureus bacteraemia would aid clinicians in targeting patients that benefit from expedited investigations and escalated care. Methods In this prospective observational cohort study, we aimed to identify risk factors associated with a complicated infection in community-onset S. aureus bacteraemia. Potential risk factors were collected from electronic medical records and included: - patient demographics, symptomology, portal of entry, and laboratory results. Results We identified several potential risk factors using univariate analysis. In a multiple logistic regression model, age, haemodialysis, and entry point from a diabetic foot ulcer were all significantly protective against complications. Conversely, an unknown entry point of infection, an entry point from an indwelling medical device, and a C-reactive protein concentration of over 161 mg/L on the day of admission were all significantly associated with complications. Conclusions We conclude that several factors are associated with complications including already conducted laboratory investigations and portal of entry of infection. These factors could aid the triage of at-risk patients for complications of S. aureus bacteraemia.

Resistance to protoporphyrinogen IX oxidase (PPO)-inhibitors in Amaranthus palmeri and Amaranthus tuberculatus is mainly contributed by mutations in the PPO enzyme, which renders herbicide molecules ineffective. The deletion of glycine210 (ΔG210) is the most predominant PPO mutation. ΔG210-ppo2 is overexpressed in rice (Oryza sativa c. ‘Nipponbare’) and Arabidopsis thaliana (Col-0). A foliar assay was conducted on transgenic T1 rice plants with 2× dose of fomesafen (780 g ha−1), showing less injury than the non-transgenic (WT) plants. A soil-based assay conducted with T2 rice seeds confirmed tolerance to fomesafen applied pre-emergence. In agar medium, root growth of WT rice seedlings was inhibited >90% at 5 µM fomesafen, while root growth of T2 seedlings was inhibited by 50% at 45 µM fomesafen. The presence and expression of the transgene were confirmed in the T2 rice survivors of soil-applied fomesafen. A soil-based assay was also conducted with transgenic A. thaliana expressing ΔG210-ppo2 which confirmed tolerance to the pre-emergence application of fomesafen and saflufenacil. The expression of A. palmeriΔG210-ppo2 successfully conferred tolerance to soil-applied fomesafen in rice and Arabidopsis. This mutant also confers cross-tolerance to saflufenacil in Arabidopsis. This trait could be introduced into high-value crops that lack chemical options for weed management.

(1) Background: Women using unreliable traditional contraception need to be included in the proportion of women having an &lsquo, unmet need for modern contraception&rsquo, instead of the current classification which presumes they have a &lsquo, met need&rsquo, (2) Methods: Mix methods research design comprising initial quantitative analyses utilizing data from the nationally representative 2014 Cambodian Demographic and Health Survey (CDHS) for 4823 Cambodian, sexually active females aged 15&ndash, 29 years. Then a qualitative phase explored knowledge about the menstrual cycle and misconceptions about modern contraception with 30 females aged 15&ndash, 29 years in urban Cambodia using semi-structured interviews, transcribed verbatim with quality checks. Purposive and snowball sampling strategies were used until data saturation was reached. Inductive thematic data analysis was conducted, (3) Results: Unmet need for modern contraception increased to 25.4% when traditional contraception users were included. The qualitative themes show women have a lack of information about the menstrual cycle and misconceptions about modern contraception which contributed to increased use of traditional contraception, (4) Conclusion: Major drivers of increased unmet need for modern contraception include lack of literacy, misconceptions and low autonomy to choose modern contraception. Cambodia needs to endorse a policy shift to implement targeted, countrywide sexual and reproductive health literacy and family planning services.

Background Many studies have attempted to identify the sources of interindividual variability in response to theta-burst stimulation (TBS). However, these studies have been limited by small sample sizes, leading to conflicting results. Objective/Hypothesis This study brought together over 60 TMS researchers to form the ‘Big TMS Data Collaboration’, and create the largest known sample of individual participant TBS data to date. The goal was to enable a more comprehensive evaluation of factors driving TBS response variability. Methods 118 corresponding authors of TMS studies were emailed and asked to provide deidentified individual TMS data. Mixed-effects regression investigated a range of individual and study level variables for their contribution to iTBS and cTBS response variability. Results 430 healthy participants’ TBS data was pooled across 22 studies (mean age = 41.9; range = 17–82; females = 217). Baseline MEP amplitude, age, target muscle, and time of day significantly predicted iTBS-induced plasticity. Baseline MEP amplitude and timepoint after TBS significantly predicted cTBS-induced plasticity. Conclusions This is the largest known study of interindividual variability in TBS. Our findings indicate that a significant portion of variability can be attributed to the methods used to measure the modulatory effects of TBS. We provide specific methodological recommendations in order to control and mitigate these sources of variability.

Skinfold thickness is an indicator of body fat, allowing a more detailed description of obesity. In Vietnam, there are no published percentile values for triceps and subscapular skinfold measurements from population-based studies of adolescents. This study aims to establish percentile tables for triceps, subscapular, and triceps + subscapular skinfolds (TSF + SSSF) sum. We used data from a cross-sectional survey conducted in Ho Chi Minh City. BMI, triceps and subscapular skinfold measurements of 2660 students were obtained. The L (Box-Cox transformation), M (median), and S (coefficient of variation) parameters were used to generate exact percentiles. The proportion of overweight was higher in boys (18.4% vs. 8.2%, p

Purpose: To investigate the effect of a knowledge translation intervention on knowledge and frequency of routine evidence-based assessment behaviours of healthcare professionals working with children with cerebral palsy. Methods: A before-and-after longitudinal study was conducted in five disability organisations. Four organisations (Commencing Knowledge Translation group) implemented a multifaceted intervention: knowledge brokers, targeted education, electronic-evidence library, and clinical outcomes database. These strategies were already in place at the fifth organisation (Comparison group). Outcomes evaluated at 0, 6, 12, and 24 months were health-professional knowledge and routine assessment behaviours (self-report and “completeness” of clinical assessment). Generalised estimating equations determined longitudinal changes. Results: Four hundred and forty-seven professionals involved 861 children in the study. The Comparison group had higher knowledge and routine assessment behaviours at baseline. Professional knowledge in both groups remained stable (differences in change from baseline to 24 months: 0.3 units, 95%CI: −0.76 to 1.36). Assessment completeness of the Comparison group was stable (baseline mean 68 units, 95%CI: 65–71); the Commencing Knowledge Translation group improved from baseline mean 35 units (95%CI: 33–36), peaking at 12 months (mean 68 (95%CI: 65–71). Conclusions: Multifaceted organisational support improved health-professional routine evidence-based assessment behaviours with children with cerebral palsy, despite no change in knowledge. Trial registration: This trial was not a controlled health care intervention and was registered retrospectively: ACTRN12616001616460. The protocol of the trial was published in 2015 as follows: Imms et al. [6]. Implications for rehabilitation • A multifaceted knowledge translation intervention increased allied health professionals’ assessment behaviours. • Knowledge translation strategies can be chosen to target change in knowledge and/or change in behaviour. • Knowledge translation interventions should be designed to address organisational barriers and enhance organisational supports. • Interventions that target healthcare professionals’ behaviour directly can be effective even if their knowledge does not change.

Resistance to protoporphyrinogen IX oxidase (PPO)-inhibitors in

Resistance to protoporphyrinogen oxidase (PPO)-inhibiting herbicides is endowed primarily by target-site mutations at the PPX2 gene that compromise binding of the herbicide to the catalytic domain. In Amaranthus spp. PPX2, the most prevalent target mutations are deletion of the G210 codon, and the R128G and G339A substitutions. These mutations strongly affect the dynamic of the PPO2 binding pocket, resulting in reduced affinity with the ligand. Here we investigated the likelihood of co-occurrence of the most widespread target site mutations in the same PPX2 allele.Plants carrying R128G+/+ ΔG210+/-, where + indicates presence of the mutation, were crossed with each other. The PPX2 of the offspring was subjected to pyrosequencing and E. coli-based Sanger sequencing to determine mutation frequencies and allele co-occurrence. The data show that R128G ΔG210 can occur in one allele only; the second allele carries only one mutation. Double mutation in both alleles is less likely because of significant loss of enzyme activity. The segregation of offspring populations derived from a cross between heterozygous plants carrying ΔG210 G399A also showed no co-occurrence in the same allele. The offspring exhibited the expected mutation distribution patterns with few exceptions.Homozygous double-mutants are not physiologically viable. Double-mutant plants can only exist in a heterozygous state. Alternatively, if two mutations are detected in one plant, each mutation would occur in a separate allele. © 2022 The Authors. Pest Management Science published by John WileySons Ltd on behalf of Society of Chemical Industry.

BackgroundResistance to PPO-inhibiting herbicides is primarily endowed by target site mutations at the PPO2 gene that compromise binding of the herbicide to the catalytic domain. In Amaranthus ssp. PPO2, the most prevalent target mutations are deletion of the G210 codon and the R128G and G339A substitutions. These mutations strongly affect the dynamic of the PPO2 binding pocket resulting in reduced affinity with the ligand. Here we investigated the likelihood of co-occurrence of the most widespread target site mutations in the same ppo2 allele.ResultsPlants carrying R128G+/+ ΔG210+/-, where + indicates presence of the mutation, were crossed with each other. The ppo2 of the offspring was subjected to pyrosequencing and E. coli-based Sanger sequencing to determine mutation frequencies and allele co-occurrence. The data show that R128G ΔG210 can occur only in one allele; the second allele carries only one mutation. Double mutation in both alleles is less likely because of significant loss of enzyme activity. The segregation of offspring populations derived from a cross between heterozygous plants carrying ΔG210 G399A also showed no co-occurrence in the same allele. The offspring exhibited the expected mutation distribution patterns with few exceptions.ConclusionsHomozygous double-mutants are not physiologically viable. Double-mutant plants can only exist in a heterozygous state. Alternatively, if two mutations are detected in one plant, each mutation would occur in a separate allele.NomenclaturePalmer amaranth, Amaranthus palmeri S. Wats.; protoporphyrinogen oxidase, PPO; tall waterhemp, Amaranthus tuberculatus (Moq.) J.D.Sauer

Examine Australian Football League results for evidence that game-day circadian misalignment or environmental temperature influence games with competing teams from each of Western Australia and Victoria.Retrospective observational study.Data were obtained for games (n = 791) contested by Western Australian and Victorian teams; including game location, start time, and outcome. Start times were categorised as afternoon, twilight, or night. Game-day maximum temperature (°C) for afternoon games was obtained from the Australian Bureau of Meteorology. Mixed effects generalised linear models examined evidence for a circadian advantage to Victorian teams in afternoon games, and to Western Australian teams in night games. Models examined evidence for an advantage to Western Australian teams as game-day temperature increases.Odds of winning and point margin for home games played in the afternoon, twilight, and night, were not different between Victorian and Western Australian teams (p 0.05). For afternoon games, each 1 °C increase in temperature improved odds of Western Australian teams winning by 11% (p 0.001) and their point margin by 2.1 points (p 0.001). For games played in Victoria, each 1 °C increase in temperature improved odds of Western Australian teams winning by 6% (p = 0.028) and their point margin by 1.7 points (p = 0.005).There is no evidence here that circadian misalignment between teams influences game outcomes in the AFL. Western Australian teams are more likely to win afternoon games played in warm conditions. This may reflect superior heat acclimatisation among AFL players based in Western Australia.

Background Carbohydrates are an important fuel for optimal exercise performance during moderate- and high-intensity exercise; however, carbohydrate ingestion during high-intensity exercise may cause gastrointestinal upset. A carbohydrate oral rinse is an alternative method to improve exercise performance in moderate- to high-intensity exercise with a duration of 30–75 min. This is the first systematic review and meta-analysis to comprehensively examine the isolated effect of maltodextrin-based rinsing on exercise performance. Objective The objective of this review was to establish the effect of a maltodextrin-based carbohydrate oral rinse on exercise performance across various modes of exercise. Furthermore, a secondary objective was to determine the effects of moderators [(1) participant characteristics; (2) oral rinse protocols; (3) exercise protocol (i.e. cycling, running etc.) and (4) fasting] on exercise performance while using a maltodextrin-based, carbohydrate oral rinse. Methods Five databases (MEDLINE, PsycINFO, Embase, SPORTDiscus and Global Health) were systematically searched for articles up to March 2021 and screened using Covidence (a systematic review management tool). A random effects robust meta-analysis and subgroup analyses were performed using Stata Statistical Software: Release 16. Results Thirty-five articles met the inclusion criteria and were included in the systematic review; 34 of these articles were included in the meta-analysis. When using a conventional meta-analytic approach, overall, a carbohydrate oral rinse improved exercise performance in comparison with a placebo (SMD = 0.15, 95% CI 0.04, 0.27; p = 0.01). Furthermore, when implementing an adjusted, conservative, random effects meta-regression model using robust variance estimation, overall, compared with placebo, a carbohydrate oral rinse demonstrated evidence of improving exercise performance with a small effect size (SMD = 0.17, 95% CI − 0.01, 0.34; p = 0.051). Conclusion This systematic review and meta-analysis demonstrates that a maltodextrin-based carbohydrate oral rinse can improve exercise performance. When comparing the two meta-analytic approaches, although non-significant, the more robust, adjusted, random effects meta-regression model demonstrated some evidence of a maltodextrin-based carbohydrate oral rinse improving exercise performance overall.

IntroductionChronic low back pain disorders (CLBDs) present a substantial societal burden; however, optimal treatment remains debated. To date, pairwise and network meta-analyses have evaluated individual treatment modes, yet a comparison of a wide range of common treatments is required to evaluate their relative effectiveness. Using network meta-analysis, we aim to evaluate the effectiveness of treatments (acupuncture, education or advice, electrophysical agents, exercise, manual therapies/manipulation, massage, the McKenzie method, pharmacotherapy, psychological therapies, surgery, epidural injections, percutaneous treatments, traction, physical therapy, multidisciplinary pain management, placebo, ‘usual care’ and/or no treatment) on pain intensity, disability and/or mental health in patients with CLBDs.Methods and analysisSix electronic databases and reference lists of 285 prior systematic reviews were searched. Eligible studies will be randomised controlled/clinical trials (including cross-over and cluster designs) that examine individual treatments or treatment combinations in adult patients with CLBDs. Studies must be published in English, German or Chinese as a full-journal publication in a peer-reviewed journal. A narrative approach will be used to synthesise and report qualitative and quantitative data, and, where feasible, network meta-analyses will be performed. Reporting of the review will be informed by Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidance, including the network meta-analysis extension (PRISMA-NMA). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for network meta-analysis will be implemented for assessing the quality of the findings.Ethics and disseminationEthical approval is not required for this systematic review of the published data. Findings will be disseminated via peer-reviewed publication.PROSPERO registration numberPROSPERO registration number CRD42020182039.

Poor intervertebral disc (IVD) health is associated with low back pain (LBP). This 12-week parallel randomised controlled trial will evaluate the efficacy of a progressive interval running programme on IVD health and other clinical outcomes in adults with chronic LBP. Participants will be randomised to either a digitally delivered progressive interval running programme or waitlist control. Participants randomised to the running programme will receive three individually tailored 30 min community-based sessions per week over 12 weeks. The waitlist control will undergo no formal intervention. All participants will be assessed at baseline, 6 and 12 weeks. Primary outcomes are IVD health (lumbar IVD T2 via MRI), average LBP intensity over the prior week (100-point visual analogue scale) and disability (Oswestry Disability Index). Secondary outcomes include a range of clinical measures. All outcomes will be analysed using linear mixed models. This study has received ethical approval from the Deakin University Human Research Ethics Committee (ID: 2022-162). All participants will provide informed written consent before participation. Regardless of the results, the findings of this study will be disseminated, and anonymised data will be shared via an online repository. This will be the first study to evaluate whether a progressive interval running programme can improve IVD health in adults with chronic LBP. Identifying conservative options to improve IVD health in this susceptible population group has the potential to markedly reduce the burden of disease. This study was registered via the Australian New Zealand Clinical Trials Registry on 29 September 2022 (ACTRN12622001276741).

Background: Adjunctive psychological interventions improve outcomes in bipolar disorder (BD), but people in latter, more refractory illness stages likely have different clinical needs. The objective here was to test the hypothesis that for people with >‾ 10 episodes of BD, an online mindfulness-based intervention improves quality of life (QoL) relative to a quality-matched psychoeducation control. Methods: A rater-blind, pragmatic superiority randomised clinical trial compared Mindfulness with active control (Psychoeducation). Both interventions were 5-week coach-supported self-management programs with treatment as usual continued. Key inclusion criteria were age 18 to 65 years, confirmed diagnosis of BD, and history of >‾ 10 episodes. Measures were collected at baseline, immediate post-intervention, and 3- and 6- month follow-ups. Main outcome was QoL, measured on the self-report Brief Quality of Life in Bipolar Disorder (Brief QoL.BD) at 5 weeks, using intention-to-treat analyses. The study setting was online, and randomisation was automated into the platform. The trial was prospectively registered on 23 June 2017 through ClinicalTrials.gov (http://www.clinicaltrials.gov, NCT03197974). Findings: Recruitment commenced 19 th September 2017, randomisation target reached 28 th November 2018 (N = 302 randomised) and follow-up data collection completed 6 th July 2019. The primary hypothesis of significant improvement in QoL with Mindfulness relative to Psychoeducation was not supported (Treatment X Time β = -0.69, 95% CI: -2·69, 1·31, p = 0·50). Recruitment was feasible, the platform was safe, both interventions were highly acceptable, but usage was suboptimal. Post hoc analyses found both interventions effective for participants not in remission from depression at baseline. Interpretation: In people with latter-stage BD, an online Mindfulness intervention was not superior to Psychoeducation. More effective future variants could combine mindfulness with psychoeducation content, improve engagement via personalised tailoring of QoL goals, and target more symptomatic individuals. Trial Registration: The trial was prospectively registered on 23 June 2017 through ClinicalTrials.gov (http://www.clinicaltrials.gov, NCT03197974). Funding: Supported by Australian National Health and Medical Research Council (NHMRC; APP1102097). Declaration of Interest: GM has received Grant/Research support from National Health and Medical Research Council (NHMRC), BeyondBlue Barbara Dicker Foundation, Readiness P/L, SiSU Wellness P/L – unrelated to this work, with the exception of the NHMRC funding for the project described here. MB has received Grant/Research Support from the NIH, Cooperative Research Centre, Simons Autism Foundation, Cancer Council of Victoria, Stanley Medical Research Foundation, Medical Benefits Fund, National Health and Medical Research Council, Medical Research Futures Fund, Beyond Blue, Rotary Health, A2 milk company, Meat and Livestock Board, Woolworths, Avant and the Harry Windsor Foundation, has been a speaker for Abbot, Astra Zeneca, Janssen and Janssen, Lundbeck and Merck and served as a consultant to Allergan, Astra Zeneca, Bioadvantex, Bionomics, Collaborative Medicinal Development, Janssen and Janssen, Lundbeck Merck, Pfizer and Servier – all unrelated to this work. NT has received Grant/Research Support from the Australian Government Department of Health, Australian Government Department of Veterans Affairs, Barbara Dicker Brain Sciences Foundation, NHMRC, Mental Health Commission, VicHealth and Victorian State Government Department of Health and Human Services, all unrelated to this work. LB has received Grant/Research Support from the NIH, Australasian Society for Bipolar & Depressive Disorders Ltd, GMHBA, National Health and Medical Research Council, and Servier – all unrelated to this work. SJ has received Grant/Research support from NIHR HTA, EME, RfPB and PGfAR streams all unrelated to this work. Ethical Approval: Swinburne University of Technology Human Research Ethics Committee approved the online trial (2016/289) with international recruitment.

To examine associations of unhealthy lifestyle and genetics with risk of all-cause mortality, cardiovascular disease (CVD) mortality, myocardial infarction (MI) and stroke. We used data on 76,958 adults from the UK Biobank prospective cohort study. Favourable lifestyle included no overweight/obesity, not smoking, physical activity, not sedentary, healthy diet and adequate sleep. A Polygenic Risk Score (PRS) was derived using 300 CVD-related single nucleotide polymorphisms. Cox proportional hazard ratios (HR) were used to model effects of lifestyle and PRS on risk of CVD and all-cause mortality, stroke and MI. New CVD (n = 364) and all-cause (n = 2408) deaths, and stroke (n = 748) and MI (n = 1140) events were observed during a 7.8 year mean follow-up. An unfavourable lifestyle (0–1 healthy behaviours) was associated with higher risk of all-cause mortality (HR: 2.06; 95% CI: 1.73, 2.45), CVD mortality (HR: 2.48; 95% CI: 1.64, 3.76), MI (HR: 2.12; 95% CI: 1.65, 2.72) and stroke (HR:1.74; 95% CI: 1.25, 2.43) compared to a favourable lifestyle (≥4 healthy behaviours). PRS was associated with MI (HR: 1.35; 95% CI: 1.27, 1.43). There was evidence of a lifestyle-genetics interaction for stroke (p = 0.017). Unfavourable lifestyle behaviours predicted higher risk of all-cause mortality, CVD mortality, MI and stroke, independent of genetic risk.

Few studies have derived dietary patterns based on intake of discretionary foods and beverages and examined associations with genetic risk and obesity. We examined associations between dietary patterns based on discretionary foods, saturated fatty acids (SFA), and fiber, with a polygenetic risk score (PRS) for obesity and risk of overall obesity, central obesity and high body fat (BF) up to 9.7 years later. Data from 11,735 adults from the UK Biobank cohort study were used. Dietary patterns were derived from 24-h dietary assessments using reduced rank regression (response variables: discretionary foods and beverages [%E]; SFA [%E]; fiber density [g/MJ]). Cox proportional hazard models were used to investigate associations between dietary patterns and incident overall obesity, central obesity and high BF, with interactions by PRS. Three dietary patterns (DP) were identified. DP1, correlated positively with discretionary foods and SFA, inversely with fiber, was associated with higher risk of central obesity (hazard ratio: 1.08; 95% confidence interval: 1.02, 1.14). DP2, correlated positively with discretionary foods and fiber, inversely with SFA, was not associated with obesity incidence. DP3, correlated positively with SFA and fiber, inversely with discretionary foods, was associated with lower risk of central obesity (hazard ratio: 0.92; 95% confidence interval: 0.87, 0.98). There was limited evidence of interactions with PRS. A dietary pattern high in high-SFA and low-fiber discretionary foods and beverages was associated with higher risk of obesity, independent of genetic predisposition.

Background The primary objective is to test the effectiveness of a novel online quality of life (QoL) intervention tailored for people with late stage (≥ 10 episodes) bipolar disorder (BD) compared with psychoeducation. Relative to early stage individuals, this late stage group may not benefit as much from existing psychosocial treatments. Methods An NH&MRC funded international RCT to compare the effectiveness of two 5-week adjunctive online self-management interventions: Mindfulness for Bipolar 2.0 and an active control (Psychoeducation for Bipolar). A total of 300 participants were recruited primarily via social media channels. Evaluations occurred at pre- and post- treatment, and at 3- and 6- months follow-up. A secondary outcome measure was BD-related symptoms (depression). A longitudinal analysis was conducted using random effects mixed models. Results Preliminary results suggest no change in mean QIDS_total over time (p = 0.891). Nor does there appear to be a difference in groups (B coeff= 0.47, 95%CI (-0.60, 1.55), p = 0.613) and no difference in intervention groups over time (p = 0.828). Conclusions The effectiveness of a novel QoL focused, mindfulness based, online guided self-help intervention for late stage BD does not appear to have been any more effective than a psychoeducation intervention for reducing depression. Key messages There may be no significant benefit from using a mindfulness based, online guided self-help intervention over a psychoeducation intervention to reduce the BD symptoms of depression in late stage Bipolar disorder.

Background Migrants may be more likely to experience occupational health inequities (OHIs) than native-born workers due to higher occupational exposure, higher vulnerability to exposure-associated health impacts, or both. This study explores migrant status-related differences in vulnerability to job stressor exposures in terms of mental health in Australia. Methods Data were from wave 14 of the Household Income and Labour Dynamics in Australia Survey. Migrant status was defined by country of birth (COB), the dominant language of COB, and the years since arrival in Australia. Job stressors included skill discretion, decision authority, and job insecurity. Mental health was assessed using the Mental Health Inventory-5 score (MHI-5). Data were analysed using linear regression, adjusting for gender, age, and education. Migrant status was analysed as the effect modifier of job stressor—mental health relationships. Results As expected, skill discretion and decision authority were positively, while job insecurity was negatively associated with the MHI-5 score. However, there was no statistical evidence of migrant status acting as an effect modifier of job stressor—mental health relationships even though the dominant language of COB and years since arrival in Australia have been taken into account. Conclusions The magnitudes of job stressor—mental health relationships do not differ between migrant workers and Australia-born workers. Key messages Differential exposure rather than differential vulnerability is a more important mechanism for generating occupational mental health inequities between migrants and Australian-born workers. Reducing job stressor exposures could reduce the OHIs among migrant workers in Australia.

Background Noncommunicable diseases (NCDs) are a growing global health challenge disproportionately impacting low- and middle-income settings, including Ethiopia. Currently, the body of evidence describing the burden of NCDs is fragmented, inconsistent, health facility- or institution-based, and out-dated in Ethiopia. We conducted a systematic review of the literature and meta-analysis of the prevalence of NCDs in community settings in Ethiopia. Review methodology Community-based quantitative studies published in English between 2012 and July 2020 that reported the prevalence of NCDs in Ethiopia were included. A systematic search of Medline, Embase, Scopus, CINHAL, and Global Health using pretested search terms related to NCDs was conducted, and data were extracted using a piloted data extraction proforma adapted from the Joanna Briggs Institute tool. Meta-analysis was performed using Stata 16. We measured the overall NCD prevalence using pooled odds ratios with 95% CIs. Pooled NCD prevalence was also computed and presented using forest plots. I2 was used to assess heterogeneity. Studies that did not fulfil the criteria for meta-analysis were narratively synthesised. Results Nineteen studies met the inclusion criteria. Four studies measured the prevalence of NCDs (all NCDs together), ranging from 29% to 35% (prevalence estimates not pooled). The pooled prevalence of Diabetes Mellites (DM) across ten studies was 5% (95% CI:4%−7%). Three studies each reported on the prevalence of undiagnosed DM (pooled prevalence 8%, 95% CI: 2%−14%) and pre-DM (pooled prevalence 12%, 95% CI:3%−21%). In a narrative analysis the prevalence of cardiovascular conditions ranged from 13.4% to 32.2% (n = 3 studies), cancer mortality ranged from 4% to 18% (n = 3 studies) and respiratory conditions ranged from 1% to 18% (n = 3 studies). Conclusion and recommendations Our analysis found that approximately one-third of Ethiopians have an NCD, with cardiovascular diseases the most common of all NCDs. The prevalence of respiratory conditions also appears high, but there are insufficient data for a pooled estimate. Whilst the prevalence of DM appears relatively low, there is evidence that the magnitude is increasing. Public health actions to address the high burden of cardiovascular and respiratory diseases, as well as the increasing magnitude of DM in Ethiopia, must be prioritised. Keywords: NCD, noncommunicable diseases, Ethiopia.

In Arkansas, resistance to protoporphyrinogen IX oxidase (PPO)-inhibiting herbicides in Amaranthus palmeri S. Wats. is mainly due to target site mutations. Although A. palmeri PPO-mutations are well investigated, the cross-resistance that each ppo mutant endows to weed populations is not yet well understood. We aimed to evaluate the response of PPO-resistant A. palmeri accessions, harboring the ppo2 mutations ΔG210 and G399A, to multiple PPO-inhibiting herbicides. Six resistant and one susceptible field accessions were subjected to a dose–response assay with fomesafen, and selected survivors from different fomesafen doses were genotyped to characterize the mutation profile. The level of resistance to fomesafen was determined and a cross-resistance assay was conducted with 1 and 2 times the labeled doses of selected PPO herbicides. The accession with higher predicted dose to control 50% of the population (ED50) had a higher frequency of ΔG210-homozygous survivors. Survivors harboring both mutations, and those that were ΔG210-homozygous, incurred less injury at the highest fomesafen rate tested (1120 g ai ha−1). The populations with a high frequency of ΔG210-homozygous survivors, and those with individuals harboring ΔG210 + G399A mutations, exhibited high potential for cross-resistance to other PPO herbicides. The new PPO–herbicide chemistries (saflufenacil, trifludimoxazin) generally controlled the PPO-resistant populations.

OBJECTIVES: Previous research has investigated whether the apolipoprotein E (APOE) e4 allele, which is associated with an increased risk of cognitive decline, is also associated with hearing loss in older people. Results of the very limited research to date are conflicting, and sample sizes for all but one study were small. The present study aimed to investigate whether there is an association between the APOE e4 allele and hearing loss in a large, population-based sample of community-dwelling older adults. DESIGN: Cross-sectional audiometric data on hearing levels and APOE genotypes for 2006 participants (aged 55 to 85 years) of the Hunter Community Study were analyzed using multiple linear regression to examine the association between APOE e4 carrier status and the 4-frequency pure-tone average (0.5 to 4 kHz) in the better hearing ear, and also across individual frequencies in the better ear. RESULTS: Observed and expected APOE allele frequency distributions did not differ significantly overall from established general population allele frequency distributions. Unadjusted modeling using better ear pure-tone average showed a statistically significant association between APOE e4 allele status (0, 1, 2 copies) and reduced hearing loss, but when the model was adjusted for age, this was no longer statistically significant. Across individual hearing frequencies, unadjusted regression modeling showed APOE e4 status was significantly associated with a reduction in mean hearing thresholds at 1 and 2 kHz, but again this effect was no longer statistically significant after adjusting for age. CONCLUSIONS: The results of this study did not provide any evidence of a statistically significant association between APOE e4 allele status and hearing loss for older adults. Further investigation of the effect of homozygous carrier status on hearing thresholds is required.

Fatty acid taste (FAT) perception is involved in the regulation of dietary fat intake, where impaired FAT is associated with increased fatty food intake. There are a number of FAT receptors identified on human taste cells that are potentially responsible for FAT perception. Manipulating dietary fat intake, and in turn FAT perception, would elucidate the receptors that are associated with long-term regulation of FAT perception. The present study aimed to assess associations between diet-mediated changes to FAT receptors and FAT perception in humans. A co-twin randomised controlled trial was conducted, where each matching twin within a pair were randomly allocated to either an 8-week low-fat (LF; 35 % energy fat) diet. At baseline and week 8, fungiform papillae were biopsied in the fasted state and FAT receptor gene expressions (cluster of differentiation 36 (CD36), free fatty acid receptor 2 (FFAR2), FFAR4, G protein-coupled receptor 84 (GPR84) and a delayed rectifying K+ channel (K+ voltage-gated channel subfamily A member 2; KCNA2)) were measured using RT-PCR; and FAT threshold (FATT) was assessed using three-alternate forced choice methodology. Linear mixed models were fitted, adjusting for correlation between co-twins. Intake was compliant with the study design, with the LF and HF groups consuming 14·8 and 39·9 % energy from fat, respectively. Expression of FFAR4 increased by 38 % in the LF group (P = 0·023; time–diet interaction P = 0·063). ΔFFAR4 (Δ, week 8–baseline) was associated with Δfat intake (g) ( = −159·4; P < 0·001) and ΔFATT ( = −8·8; P = 0·016). In summary, FFAR4 is involved in long-term diet-mediated changes to FAT perception. Manipulating dietary fat intake, and therefore FFAR4 expression, might aid in reducing taste-mediated passive overconsumption of fatty foods.