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BACKGROUND: The Augmented versus Routine Approach to Giving Energy Trial (TARGET) was a 4000-patient trial in which augmented enteral calorie dose did not influence outcomes. AIM: We aimed to quantify practice change following TARGET. METHODS: Three single-day, prospective, multicentre, point-prevalence audits of adult patients receiving enteral nutrition (EN) in participating Australian and New Zealand intensive care units at 10:00 AM were conducted: (i) 2010 (before conducting TARGET); (ii) 2018 (immediately before publishing TARGET results); and (iii) 2020 (2 years after TARGET publication). Data included baseline characteristics, clinical outcomes, and nutrition data. Data are n (%), mean ± standard deviation, or median [interquartile range]. Differences in enteral calorie prescription between 2018 and 2020 were compared using the Mann-Whitney test. RESULTS: The percentage of patients receiving EN (2010 42%, 2018 38%, 2020 33%; P = 0.012) and the prescription of calorie-dense EN formula (≥1.5 kcal/ml) (2010 33%, 2018 24%, 2020 23%; P = 0.038) decreased over time. However, when comparing prepublication and postpublication (2018-2020), calorie dose and calorie density were similar: 22.9 ± 8.6 versus 23.4 ± 12.8 kcal/kg/day (P = 0.816) and <1.5 kcal/ml: 76 versus 77% (P = 0.650), respectively. CONCLUSION: In Australian and New Zealand intensive care units, enteral calorie dose and calorie density of prescribed EN were similar before TARGET publication and 2 years later.

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BACKGROUND: TB preventive treatment (TPT) reduces morbidity and mortality among people living with HIV (PLHIV). Despite the successful scale-up of TPT in Malawi, monitoring and evaluation have been suboptimal. We utilized the Malawi Population-Based HIV Impact Assessment (MPHIA) 2020-2021 survey data to estimate TPT uptake and completion among self-reported HIV-positive persons. METHODS: We estimated the proportion of HIV-positive respondents who had ever undergone TPT, and determined the percentage of those currently on TPT who had completed more than 6 months of treatment. Bivariate and multivariable logistic regression were performed to calculate the odds ratios for factors associated with ever-taking TPT. All variables were self-reported, and the analysis was weighted and accounted for in the survey design. RESULTS: Of the HIV+ respondents, 38.8% (95% CI 36.4-41.3) had ever taken TPT. The adjusted odds of ever taking TPT were 8.0 and 5.2 times as high in the Central and Southern regions, respectively, compared to the Northern region; 1.9 times higher among those in the highest wealth quintile, and 2.1 times higher for those on antiretroviral therapy >10 years. Of those currently taking TPT, 56.2% completed >6 months of TPT. CONCLUSION: These results suggest low TPT uptake and >6 months' completion rates among self-reported HIV+ persons. Initiatives to create demand and strengthen adherence would improve TPT uptake.

CONTEXTE: Le traitement préventif de la TB (TPT) réduit la morbidité et la mortalité chez les personnes vivant avec le VIH (PVVIH). Malgré l'extension réussie du TPT au Malawi, le suivi et l'évaluation n'ont pas été optimaux. Nous avons utilisé les données de l'enquête MPHIA (Malawi Population-Based HIV Impact Assessment) 2020­2021 pour estimer l'adoption et l'achèvement du TPT parmi les personnes se déclarant séropositives. MÉTHODES: Nous avons estimé la proportion de répondants séropositifs qui avaient déjà subi un TPT et déterminé le pourcentage de ceux qui sont actuellement sous TPT et qui ont terminé plus de 6 mois de traitement. Une régression logistique bivariée et multivariable a été effectuée pour calculer les rapports de cotes des facteurs associés au fait d'avoir déjà pris un TPT. Toutes les variables étaient autodéclarées et l'analyse a été pondérée et prise en compte dans la conception de l'enquête. RÉSULTATS: Parmi les répondants séropositifs, 38,8% (IC 95% 36,4­41,3) avaient déjà pris du TPT. Les probabilités ajustées de prise de TPT étaient 8,0 et 5,2 fois plus élevées dans les régions du centre et du sud, respectivement, que dans la région du nord ; 1,9 fois plus élevées chez les personnes appartenant au quintile de richesse le plus élevé, et 2,1 fois plus élevées chez les personnes suivant une thérapie antirétrovirale depuis plus de 10 ans. Parmi ceux qui prennent actuellement un TPT, 56,2% ont terminé >6 mois de TPT. CONCLUSION: Ces résultats suggèrent un faible taux d'utilisation du TPT et des taux d'achèvement de >6 mois parmi les personnes déclarées séropositives. Des initiatives visant à créer une demande et à renforcer l'adhésion permettraient d'améliorer l'utilisation du TPT.

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Screening for depression may identify persons for HIV prevention services and to ensure linkage to care for ART and mental health. We assessed factors associated with depressive symptoms using multiple logistic regression among 15- to 29-year-old gay, bisexual or other men who have sex with men (MSM) and transgender women who have sex with men (TGW) attending HIV prevention clinics at Silom Community Clinic or Bangrak Hospital in Bangkok or Rainbow Clinic in Nakhon Sawan, Thailand. We defined depressive symptoms as a self-report of feelings of sadness that impacted daily life in the past one month. Among 192 MSM, 51 TGW, and 11 gender-questioning persons screened: 12.6% met the criteria for depression; 5.9% had new HIV diagnosis. Independently associated factors which increase the risk of depressive symptoms included: studying in a private school (AOR 7.17); experiencing any type of bullying (AOR 2.8); having a partner with HIV (AOR 4.1); and learning about the study from sources other than a friend (AOR 4.2). Given many youths had depressive symptoms, screening for depression and connection to mental health services would be beneficial in sexual health settings to meet the needs of HIV-vulnerable youth.

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Pulmonary transit time (PTT), defined as the time taken for a contrast agent bolus to pass from the right ventricle to the left ventricle, is a surrogate for non-invasive assessment of preload. It is used in several imaging modalities: pulmonary angiography, echocardiography and cardiac magnetic resonance (CMR). Many recent studies have highlighted the prognostic value of PTT. Therefore, we sought to evaluate PTT in a consecutive cohort of patients undergoing CMR. We retrospectively evaluated PTT normalised for heart rate in 278 patients (66% male, mean age 58 ± 11 years) who underwent CMR between August 2017 and November 2021 with a diagnosis of dilated cardiomyopathy, infarct, hypertrophy, valvular, myocarditis, other pathology or no pathology ("normal"). Normalised pulmonary transit time (nPTT) was higher in men than in women (8.4 ± 1.3 beats vs 7.5 ± 1.1 beats, p = 0.002) in the "normal" group. nPTT was moderately correlated with left ventricular end-diastolic volume (LVEDV) (r2 = 0.19; p < 0.001), left ventricular end-systolic volume (LVESV) (r2 = 0.34; p < 0.001) and left ventricular ejection fraction (LVEF) (r2 = 0.29; p < 0.001). nPTT was significantly higher in patients with dilated cardiomyopathy (11.3 ± 5.4 beats; p < 0.001), infarct (9.5 ± 2.9 beats; p < 0.001) or valvular heart disease (9.5 ± 3.1 beats; p = 0.006) than in patients included in the "normal" group (7.9 ± 1.3 beats). The nPTT is an important marker of pathology. Its value depends on sex and type of pathology, but it is not specific for any type of pathology.

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BACKGROUND: This pilot prospective study investigated the effect of a periodic fasting mimicking diet (FMD) on metabolic health factors in patients with Prostate Cancer (PC). There is a well-documented association between PC and metabolic health. Impaired metabolic health is a significant risk factor for the development of PC, and a metabolic syndrome can be induced by hormonal therapies commonly required for its management. (ClinicalTrials.gov Identifier: NCT04292041). METHODS: We introduced a periodic 4-day FMD -low in calories, sugars, and proteins but high in unsaturated fats -to a cohort of PC patients and features of metabolic syndrome. 29/35 patients completed 3-monthly cycles of the 4-consecutive day packaged FMD. We compared the subjects' baseline weight, abdominal circumference (AC), blood pressure (BP) and selected laboratory results to the same measurements 3-months after completing the FMD cycles. RESULTS: Several important metabolic factors showed improvements post-intervention. On average patients' weights dropped by 3.79 kg (95% CI: -5.61, -1.97, p = 0.0002). AC was reduced on average by 4.57 cm, (95% CI: -2.27, -6.87, p = 0.0003). There was also a decrease in systolic and diastolic BP by 9.52 mmHg (95% CI: -16.16, -2.88, p = 0.0066) and 4.48 mmHg (95% CI: -8.85, -0.43, p = 0.0316) respectively. A sub-analysis indicates that FMD had more relevant effects in 'at-risk' patients than those with normal values of risk factors for metabolic syndrome. For example, subjects with baseline levels of systolic BP > 130 mmHg experienced a greater reduction in BP(-16.04 mmHg, p = 0.0001) than those with baseline systolic BP < 130 mmHg (-0.78 mmHg, p = 0.89). CONCLUSIONS: The FMD cycles were safely introduced to this small cohort of PC patients with little or no observed toxicity, and a high overall compliance of 83%. Analysis of the metabolic variables showed an overall decrease in weight, AC, and BP. Larger clinical trials focused on metabolic risk factors, PC quality of life and progression free survival are needed to assess the effect of the FMD on prostate cancer patients.

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Aim Ladies Gaelic football and Camogie are leading female sports in Ireland. Referees are essential to the game, however, no research has examined injury in referees that officiate over female Gaelic games to date. Therefore, this study aims to retrospectively examine the musculoskeletal injury profile and injury prevention practices of referees that officiate over female Gaelic games. Methods A retrospective anonymous questionnaire examined injuries that occurred in the previous 12 months in currently active Ladies Gaelic football and Camogie referees (n=170). Incidence and repeat incidence proportions were calculated along with descriptive statistics. Results In 2019, 42.9% (n=73) of referees sampled sustained an injury with 27.4% (n=20) sustaining two or more. Injuries primarily occurred to the lower extremity (79.6%,n=78), particularly the lower leg (20.4%,n=20) and knee (18.4%,18). Muscle strains and cramps (55.1%,n=54) were most frequent and injuries predominantly occurred during games (71.4%,n=70). Referees largely completed a warm-up but just 30.6% (n=52) conducted a cool-down. Over half had undertaken injury prevention education but only 37.6% (n=64) incorporated injury prevention elements into their training. Conclusion Just over two in five referees that officiate female Gaelic games became injured in the previous year, however their utilisation of injury prevention strategies, beyond completing a warm-up, is lacking. Thus, a referee specific injury prevention programme should be developed and if found to be effective, incorporated into a comprehensive injury prevention strategy by the governing bodies.

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INTRODUCTION: Short-term electrocardiogram (ECG) examinations of horses may not detect paroxysmal arrhythmias. Twenty-four hour Holter equipment can be unwieldy and inconvenient for long-term use. This study evaluated a novel long-term ECG patch recorder, the Carnation Ambulatory Monitor (CAM) in horses, determining ideal placement, practicality, durability and performance. ANIMALS: Twenty-one adult mixed-breed horses. METHODS: Prospective observational study. Three horses had ECG patches fitted at selected sites (phase 1); the two most promising sites were used for further wear testing (phase 2) and the best site was chosen for a trial in 18 horses (phase 3), 16 of which had presented for evaluation of cardiac disease. In phase 1, the CAM was compared with a standard telemetric ECG. The CAM ECGs were analysed using proprietary software. RESULTS: The most promising sites for CAM placement were the ventral midline caudal to the xiphisternum and left thorax caudal to the girth. The ventral midline was chosen for further evaluation. The CAM provided reliable and generally excellent ECG quality at rest (median quality score 4.5/5, range 3-5), over extended periods, allowing detection of arrhythmias. The ECG quality was poor during exercise (median quality score 1, range 1-5), except in three horses. In 15/17 placements in the standing horse, greater than 85% of the potential recording time was achieved. CONCLUSIONS: The CAM is a convenient and well-tolerated device for evaluating equine cardiac rhythm at rest over long periods. Further evaluation of the ideal placement site during exercise may increase its diagnostic utility.

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Clinicians are routinely subjected to intense and stressful working environments, and the current COVID-19 crisis increases their risk of psychological distress. Mindfulness has been shown to improve life satisfaction, resilience to stress, self-compassion, compassion and general well-being in healthcare workers. Based on their clinical experience, the authors present mindfulness moments for clinicians (MMFC), a selection of short, simple and accessible mindfulness practices to promote resilience and compassion among clinicians working in this pandemic. The practices can be used on the job and are accessible to both novice and experienced meditators. Most of these practices are extracted from evidence-based mindfulness programmes. Further research is indicated to assess the effectiveness of using MMFC to support clinicians in their work and to promote resilience.

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OBJECTIVE: Jockeys compete in a sport, horseracing, renowned for its physical and psychological demands. Previous research has identified that common mental disorders (CMDs) may be prevalent among this unique population of athletes. The aim of the present study was to further explore the prevalence of CMDs among jockeys and to test for associations with potential risk factors. METHODS: An anonymous survey was distributed to professional jockey online. Self-report screening tools for four CMDs (psychological distress, depression, generalized anxiety, and adverse alcohol use) were included alongside predictor variables from questionnaires assessing for burnout, career satisfaction, social support, and the contemplation of retirement. Binary logistic regression was used to explore associations between CMDs (present versus not present) and risk factors. Eighty-four professional jockeys completed the questionnaire (response rate = 52%). RESULTS: In total, 79% of jockeys met the threshold for at least one CMD. Prevalence (%) of CMD varied as follows: adverse alcohol (61%), depression (35%), generalized anxiety (27%), and psychological distress (19%). Burnout, career (dis)satisfaction, lower levels of social support, and the contemplation of retirement increased the odds of meeting the criteria for CMDs. CONCLUSION: The findings indicate that jockeys report CMD symptoms at comparable rates to athletes in other sports. The study was the first to highlight potential risk factors as predictors of CMDs among jockeys, including burnout, career satisfaction, and the current contemplation of retirement. Screening tools for the risk factors demonstrated may, therefore, provide useful in the early identification of CMDs among jockeys. The development of jockey-specific assessment tools, education programmes, and interventions may help better understand and support the mental health of jockeys.

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OBJECTIVES: To assess feasibility of a future randomised controlled trial (RCT) of clinical and cost-effectiveness of lifestyle information and commercial weight management groups to support postnatal weight management to 12 months post-birth. DESIGN: Two-arm feasibility trial, with nested mixed-methods process evaluation. SETTING: Inner-city unit, south England. POPULATION: Women with body mass indices (BMIs) ≥25 kg/m2 at pregnancy booking or normal BMIs (18.5-24.9 kg/m2 ) identified with excessive gestational weight gain at 36 weeks of gestation. METHODS: Randomised to standard care plus commercial weight management sessions commencing 8-16 weeks postnatally or standard care only. MAIN OUTCOMES: Feasibility outcomes included assessment of recruitment, retention, acceptability and economic data collation. Primary and secondary end points included difference between groups in weight 12 months postnatally compared with booking (proposed primary outcome for a future trial), diet, physical activity, smoking, alcohol, mental health, infant feeding, NHS resource use. RESULTS: In all, 193 women were randomised: 98 intervention and 95 control; only four women had excessive gestational weight gain. A slightly greater weight change was found among intervention women at 12 months, with greatest benefit. Among women attending ten or more weight management sessions. There was >80% follow up to 12 months, low risk of contamination and no group differences in trial completion. CONCLUSION: It was feasible to recruit and retain women with BMIs ≥25 kg/m2 to an intervention to support postnatal weight management; identification of excessive gestational weight gain requires consideration. Economic modelling could inform out-of-trial costs and benefits in a future trial. A definitive trial is an important next step. TWEETABLE ABSTRACT: A feasibility RCT of postnatal weight support showed women with BMIs ≥25 kg/m2 can be recruited and followed to 12 months postnatally.

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OBJECTIVE: To evaluate whether vaginoscopy or standard hysteroscopy was more successful in the outpatient setting. DESIGN: Randomised controlled multicentre trial. SETTING: Outpatient hysteroscopy clinics at two UK hospitals. POPULATION: 1597 women aged 16 or older undergoing an outpatient hysteroscopy. METHODS: Women were allocated to vaginoscopy or standard hysteroscopy using third party randomisation stratified by menopausal status with no blinding of participants or clinicians. MAIN OUTCOME MEASURES: The primary outcome was 'success', a composite endpoint defined as: a complete procedure, no complications, a level of pain acceptable to the patient, and no sign of genitourinary tract infection 2 weeks after the procedure. RESULTS: Vaginoscopy was significantly more successful than standard hysteroscopy [647/726 (89%) versus 621/734 (85%), respectively; relative risk (RR) 1.05, 95% CI 1.01-1.10; P = 0.01]. The median time taken to complete vaginoscopy was 2 minutes compared with 3 minutes for standard hysteroscopy (P < 0.001). The mean pain score was 42.7 for vaginoscopy, which was significantly less than standard hysteroscopy 46.4 (P = 0.02). Operative complications occurred in five women receiving vaginoscopy and 19 women receiving standard hysteroscopy (RR 0.26, 95% CI 0.10-0.69). CONCLUSIONS: Vaginoscopy is quicker to perform, less painful, and more successful than standard hysteroscopy and therefore should be considered the technique of choice for outpatient hysteroscopy. TWEETABLE ABSTRACT: Vaginoscopy is quicker to perform, less painful, and more successful than standard hysteroscopy.

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Cytogenomic investigations of haematological neoplasms, including chromosome banding analysis, fluorescence in situ hybridisation (FISH) and microarray analyses have become increasingly important in the clinical management of patients with haematological neoplasms. The widespread implementation of these techniques in genetic diagnostics has highlighted the need for guidance on the essential criteria to follow when providing cytogenomic testing, regardless of choice of methodology. These recommendations provide an updated, practical and easily available document that will assist laboratories in the choice of testing and methodology enabling them to operate within acceptable standards and maintain a quality service.

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Aims Despite no previous research, it is anecdotally reported that hurling and camogie players modify their helmet and faceguard, which is against GAA regulations and can potentially increase injury risk. This study aimed to establish the prevalence and rationale behind modifications in hurling and camogie. Methods An online questionnaire was completed by 304 players aged over 18 (62% hurlers, 38% camogie players) which consisted of 27 questions. Results Appearance (43%) was the primary reasons for helmet brand choice, with just 1.6% citing safety as a main reason for choice. Surprisingly, 8% of helmets were already modified when purchased and 31% of participants made further modifications, primarily switching faceguards and removal of bars. Restricted vision, comfort and perceived poor quality of the helmet/faceguard were the most common reasons for modification. Players predominantly (75.8%) agreed that further education on modifications is required. Conclusion Future research on the relationship between helmet/faceguard modification and injury risk is required.

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Archaeological evidence suggests that dogs were introduced to the islands of Oceania via Island Southeast Asia around 3,300 years ago, and reached the eastern islands of Polynesia by the fourteenth century AD. This dispersal is intimately tied to human expansion, but the involvement of dogs in Pacific migrations is not well understood. Our analyses of seven new complete ancient mitogenomes and five partial mtDNA sequences from archaeological dog specimens from Mainland and Island Southeast Asia and the Pacific suggests at least three dog dispersal events into the region, in addition to the introduction of dingoes to Australia. We see an early introduction of dogs to Island Southeast Asia, which does not appear to extend into the islands of Oceania. A shared haplogroup identified between Iron Age Taiwanese dogs, terminal-Lapita and post-Lapita dogs suggests that at least one dog lineage was introduced to Near Oceania by or as the result of interactions with Austronesian language speakers associated with the Lapita Cultural Complex. We did not find any evidence that these dogs were successfully transported beyond New Guinea. Finally, we identify a widespread dog clade found across the Pacific, including the islands of Polynesia, which likely suggests a post-Lapita dog introduction from southern Island Southeast Asia.

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Deficits in trunk control predict ACL injuries which frequently occur during high-risk activities such as cutting. However, no existing trunk control/core stability program has been found to positively affect trunk kinematics during cutting activities. This study investigated the effectiveness of a 6-week dynamic core stability program (DCS) on the biomechanics of anticipated and unanticipated side and crossover cutting maneuvers. Thirty-one male, varsity footballers participated in this randomized controlled trial. Three-dimensional trunk and lower limb biomechanics were captured in a motion analysis laboratory during the weight acceptance phase of anticipated and unanticipated side and crossover cutting maneuvers at baseline and 6-week follow-up. The DCS group performed a DCS program three times weekly for 6 weeks in a university rehabilitation room. Both the DCS and control groups concurrently completed their regular practice and match play. Statistical parametric mapping and repeated measures analysis of variance were used to determine any group (DCS vs control) by time (pre vs post) interactions. The DCS resulted in greater internal hip extensor (P=.017, η2 =0.079), smaller internal knee valgus (P=.026, η2 =0.076), and smaller internal knee external rotator moments (P=.041, η2 =0.066) during anticipated side cutting compared with the control group. It also led to reduced posterior ground reaction forces for all cutting activities (P=.015-.030, η2 =0.074-0.105). A 6-week DCS program did not affect trunk kinematics, but it did reduce a small number of biomechanical risk factors for ACL injury, predominantly during anticipated side cutting. A DCS program could play a role in multimodal ACL injury prevention programs.

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Low adherence to guidelines for weight-related behaviours (e.g. dietary intake and physical activity) among US children underscores the need to better understand how parental factors may influence children's obesity risk. In addition to most often acting as primary caregiver to their children, women are also known to experience greater levels of stress than men. This study systematically reviewed associations between maternal stress and children's weight-related behaviours. Our search returned 14 eligible articles, representing 25 unique associations of maternal stress with a distinct child weight-related behaviour (i.e. healthy diet [n = 3], unhealthy diet [n = 6], physical activity [n = 7] and sedentary behaviour [n = 9]). Overall, findings for the relationship between maternal stress and children's weight-related behaviours were mixed, with no evidence for an association with children's healthy or unhealthy dietary intake, but fairly consistent evidence for the association of maternal stress with children's lower physical activity and higher sedentary behaviour. Recommendations for future research include prioritizing prospective designs, identifying moderators, and use of high-resolution, real-time data collection techniques to elucidate potential mechanisms.

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