Consequences of how third sector organisations are commissioned in the NHS and local authorities in England: a mixed-methods study.

Background: As a matter of policy, voluntary, community and social enterprises contribute substantially to the English health and care system. Few studies explain how the National Health Service and local authorities commission them, what outputs result, what contexts influence these outcomes and what differentiates this kind of commissioning. Objectives: To explain how voluntary, community and social enterprises are commissioned, the consequences, what barriers both parties face and what absorptive capacities they need. Design: Observational mixed-methods realist analysis: exploratory scoping, cross-sectional analysis of National Health Service Clinical Commissioning Group spending on voluntary, community and social enterprises, systematic comparison of case studies, action learning. Social prescribing, learning disability support and end-of-life care were tracers. Setting: Maximum-variety sample of six English local health and care economies, 2019-23. Participants: Commissioning staff; voluntary, community and social enterprise members. Interventions: None; observational study. Main outcome measures: How the consequences of commissioning compared with the original aims of the commissioners and the voluntary, community and social enterprises: predominantly qualitative (non-measurable) outcomes. Data sources: Data sources were: 189 interviews, 58 policy and position papers, 37 items of rapportage, 692,659 Clinical Commissioning Group invoices, 102 Freedom of Information enquiries, 131 survey responses, 18 local project group meetings, 4 national action learning set meetings. Data collected in England during 2019-23. Results: Two modes of commissioning operated in parallel. Commodified commissioning relied on creating a principal-agent relationship between commissioner and the voluntary, community and social enterprises, on formal competitive selection ('procurement') of providers. Collaborative commissioning relied on 'embedded' interorganisational relationships, mutual recognition of resource dependencies, a negotiated division of labour between organisations, and control through persuasion. Commissioners and voluntary, community and social enterprises often worked around the procurement regulations. Both modes were present everywhere but the balance depended inter alia on the number and size of voluntary, community and social enterprises in each locality, their past commissioning experience, the character of the tracer activity, and the level of deprivation and the geographic dispersal of the populations served. The COVID-19 pandemic produced a shift towards collaborative commissioning. Voluntary, community and social enterprises were not always funded at the full cost of their activity. Integrated Care System formation temporarily disrupted local co-commissioning networks but offered a longer-term prospect of greater voluntary, community and social enterprise influence on co-commissioning. To develop absorptive capacity, commissioners needed stronger managerial and communication capabilities, and voluntary, community and social enterprises needed greater capability to evidence what outcomes their proposals would deliver. Limitations: Published data quality limited the spending profile accuracy, which did not include local authority commissioning. Case studies did not cover London, and focused on three tracer activities. Absorptive capacity survey was not a random sample. Conclusions: The two modes of commissioning sometimes conflicted. Workarounds arose from organisations' embeddedness and collaboration, which the procurement regulations often disrupted. Commissioning activity at below its full cost appears unsustainable. Future work: Spending profiles of local authority commissioning; analysis of commissioning in London and of activities besides the present tracers. Analysis of absorptive capacity and its consequences, adjusting the concept for application to voluntary, community and social enterprises. Comparison with other health systems' commissioning of voluntary, community and social enterprises. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128107) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 39. See the NIHR Funding and Awards website for further award information.

National Health Service commissioners and local councils often buy health and care services from voluntary, community and social enterprises. This study aimed to explore how commissioners and voluntary, community and social enterprises worked together and where improvements could be made. We talked to commissioners and voluntary, community and social enterprises in six areas across England and focused on services for learning disabilities, social prescribing and end-of-life care. We analysed National Health Service financial accounts to see how much the National Health Service was spending on services provided by voluntary, community and social enterprises. We surveyed how commissioners and voluntary, community and social enterprises were using information and knowledge to make decisions. We organised events bringing together commissioners and voluntary, community and social enterprises to share knowledge and experience. We found there were two ways commissioners bought services from voluntary, community and social enterprises. One was commodified (a buying-and-selling model), the other collaborative (based on working together). Both were happening at the same time in all the areas of the study, but usually one of them was more present than the other. We saw a general move towards collaboration, but some areas were further along with this than others. Various things helped commissioners and voluntary, community and social enterprises collaborate, such as: paying voluntary, community and social enterprises enough for their services; having people and networks that encouraged others to work with voluntary, community and social enterprises; and including voluntary, community and social enterprises in making decisions about health and care. Commissioners and voluntary, community and social enterprises might therefore lean further towards working together to see how collaborative commissioning can be further developed; how to make contract prices cover voluntary, community and social enterprises' costs; how to enable longer-term contracts; and how to enable less hurried, more considered ways of renewing contracts (e.g. by putting draft contract specifications out to pre-tender consultation). The new Integrated Care Systems in local areas could encourage all this to happen, but pressures elsewhere in the health and care sector might make it more difficult.

Investigating premotor corticospinal excitability in fast and slow voluntary contractions of the elbow flexors.

Corticospinal excitability (CSE) increases prior to a voluntary contraction; however, the relative contributions of premotor cortical and spinal mechanisms are poorly understood. It is unknown whether the intended voluntary contractile rate affects CSE. Eighteen young, healthy participants (nine females) completed isometric elbow flexion contractions targeting 50% maximal voluntary contraction (MVC) torque, at either fast (fast as possible) or slow (25% MVC/s) contractile rates. Participants were cued to contract with warning (red) and "GO" (green) visual signals. Magnetic and electric stimulations were applied to elicit motor evoked potentials (MEPs), cervicomedullary evoked potentials (CMEPs), and M-waves, in the surface electromyogram (EMG) recorded over the biceps brachii. MEPs and CMEPs were collected at 0, 25, 50 and 75% premotor reaction time (RT - defined as the time between the "GO" cue and onset of biceps brachii EMG) and compared to a resting baseline. MEP amplitude was greater than baseline at 75% RT (p=0.009), and CMEP amplitude was significantly increased at all RT points relative to baseline (p≤0.001). However, there were no differences in MEP and CMEP amplitudes when compared between fast and slow conditions (p≥0.097). Normalized to the CMEP, there was no difference in MEP amplitude from baseline in either contractile condition (p≥0.264). These results indicate that increased premotor CSE is a spinally-mediated response. Furthermore, premotor CSE is not influenced by the intended voluntary contractile rate. CMEP amplitudes were larger for females than males within the premotor RT period (p=0.038), demonstrating that premotor spinal excitability responses may be influenced by sex.

Heartfelt choices: The influence of cardiac phase on free-choice actions.

The influence of cardiac phases on cognitive and sensorimotor functions is noteworthy. Specifically, during systole, as opposed to diastole, there is an observed enhancement in tasks demanding the suppression of instructed responses. This suggests that systole contributes to inhibitory control in motor functions. However, the extent to which systolic inhibition is significant in volitional free-choice actions, such as choosing to execute or refrain from a cue-initiated response, remains to be clarified. To fill this gap in the current literature, the purpose of this study was to test whether during the systole phase, compared with the diastole phase, the tendency to enact volitional actions decreased due to the systolic inhibitory effect. We used a modified version of the Go/No-Go task with an added condition for volitional free-choice actions, where participants could decide whether to respond or not, to test whether systolic inhibition could affect the volitional decision to act. The results showed that participants' responses were less frequent in systole than in diastole in the volitional action condition. Then, to test the robustness of the cardiac effect on volitional actions, we used two established manipulations: the Straw Breathing Manipulation and the Cold Pressor Test, which were able to induce anxiety and increase the heart rate, respectively. Results showed that the systole/diastole difference in the number of volitional action trials in which participants decided to respond tended to remain the same despite all manipulations. Overall, our results provide convergent evidence for the effect of the heart on the decision to act, an effect that appears independent of manipulations of both the physiological and psychological state of the individual.

Neuromuscular characteristics of eccentric, concentric and isometric contractions of the knee extensors.

PURPOSE: We compared voluntary drive and corticospinal responses during eccentric (ECC), isometric (ISOM) and concentric (CON) muscle contractions to shed light on neurophysiological mechanisms underpinning the lower voluntary drive in a greater force production in ECC than other contractions. METHODS: Sixteen participants (20-33 years) performed ISOM and isokinetic (30°/s) CON and ECC knee extensor contractions (110°-40° knee flexion) in which electromyographic activity (EMG) was recorded from vastus lateralis. Voluntary activation (VA) was measured during ISOM, CON and ECC maximal voluntary contractions (MVCs). Transcranial magnetic stimulation elicited motor-evoked potentials (MEPs) and corticospinal silent periods (CSP) during MVCs and submaximal (30%) contractions, and short-interval intracortical inhibition (SICI) in submaximal contractions. RESULTS: MVC torque was greater (P < 0.01) during ECC (302.6 ± 90.0 Nm) than ISOM (269.8 ± 81.5 Nm) and CON (235.4 ± 78.6 Nm), but VA was lower (P < 0.01) for ECC (68.4 ± 14.9%) than ISOM (78.3 ± 13.1%) and CON (80.7 ± 15.4%). In addition, EMG/torque was lower (P < 0.02) for ECC (1.9 ± 1.1 µV.Nm-1) than ISOM (2.2 ± 1.2 µV.Nm-1) and CON (2.7 ± 1.6 µV.Nm-1), CSP was shorter (p < 0.04) for ECC (0.097 ± 0.03 s) than ISOM (0.109 ± 0.02 s) and CON (0.109 ± 0.03 s), and MEP amplitude was lower (P < 0.01) for ECC (3.46 ± 1.67 mV) than ISOM (4.21 ± 2.33 mV) and CON (4.01 ± 2.06 mV). Similar results were found for EMG/torque and CSP during 30% contractions, but MEP and SICI showed no differences among contractions (p > 0.05). CONCLUSIONS: The lower voluntary drive indicated by reduced VA during ECC may be partly explained by lower corticospinal excitability, while the shorter CSP may reflect extra muscle spindle excitation of the motoneurons from vastus lateralis muscle lengthening.

Blood transfusion in the Caribbean: Historical perspective in the context of Trinidad and Tobago.

To compare the historical development of blood transfusion in Britain and a former British West Indian colony. International transfusion bodies recommend national coordination and exclusively voluntary non-remunerated donation as essential pre-requisites for blood safety. These ideals have been achieved in high-income countries including Great Britain, the United States of America and Canada. However, most West Indian countries have fragmented, hospital-based blood services that rely on family replacement and remunerated donors. Comparative historical analysis of blood transfusion service development in Great Britain and Trinidad and Tobago was undertaken to provide insight into their dichotomous development and inform policy decisions to bridge the gap between the two types of transfusion service. The British National Blood Transfusion service was based on voluntary non-remunerated blood donation from its inception but achieved national coordination over 50 years that included a period of regional control during which incoordination contributed to a tainted blood scandal. Failure to establish community voluntary non-remunerated donation in Trinidad and Tobago during the colonial period, before independence in 1962, allowed regionally-controlled family replacement and remunerated blood donation to become entrenched then perpetuated by path dependence. A university-led programme has recently used historically-proven methods, drawing on the experiences of the British National Blood Transfusion Service, to establish a model for developing a voluntary non-remunerated programme. The programme aims to avoid historical pitfalls during its national extension. Historical analysis provided information for introducing voluntary non-remunerated blood donation and planning a nationally-coordinated blood transfusion service.

The benefit of choice on task performance: Reduced difficulty effects in free-choice versus forced-choice tasks.

We investigated how self-determined (free) versus imposed (forced) choices influence task performance. To this end, we examined how changes in perceptual and central decision-processing difficulties affect task performance in an environment where free-choice and forced-choice tasks were intermixed. In Experiments 1 (N = 43) and 2 (N = 42), perceptual processing difficulty was varied by altering colored dot proportions (easy vs. hard color discrimination task). In Experiment 3 (N = 58), decision-processing difficulty was adjusted by changing the rotation degree of letters (easy vs. hard letter rotation task). Across all experiments, both free-choice and forced-choice performance were more impaired with harder stimuli, but this effect was generally less pronounced in freely chosen tasks. Specifically, this was evident from significant interactions between processing mode (free vs. forced) and difficulty (easy vs. hard) in the mean reaction times (RTs) for the tasks with the difficulty manipulation. Thus, processing in free-choice tasks is generally less affected by environmental changes (i.e., variation in information difficulties). We discuss how the benefit of self-determined choices over imposed choices can be explained by motivational and performance-optimization accounts, while also considering the finding that participants adjusted their task choices toward tasks with easier stimuli (i.e., significant main effect of task difficulty on choosing the task with the difficulty manipulation). Specifically, we discuss how having control over task choices might lead to more stable information processing and allow people to choose more difficult tasks when this increased difficulty has a relatively small impact on their performance.

Slow and steady-small, but insufficient, changes in food and drink availability after four years of implementing a healthy food policy in New Zealand hospitals.

BACKGROUND: A voluntary National Healthy Food and Drink Policy (the Policy) was introduced in public hospitals in New Zealand in 2016. This study assessed the changes in implementation of the Policy and its impact on providing healthier food and drinks for staff and visitors in four district health boards between 1 and 5 years after the initial Policy introduction. METHODS: Repeat, cross-sectional audits were undertaken at the same eight sites in four district health boards between April and August 2017 and again between January and September 2021. In 2017, there were 74 retail settings audited (and 99 in 2021), comprising 27 (34 in 2021) serviced food outlets and 47 (65 in 2021) vending machines. The Policy's traffic light criteria were used to classify 2652 items in 2017 and 3928 items in 2021. The primary outcome was alignment with the Policy guidance on the proportions of red, amber and green foods and drinks (≥ 55% green 'healthy' items and 0% red 'unhealthy' items). RESULTS: The distribution of the classification of items as red, amber and green changed from 2017 to 2021 (p < 0.001) overall and in serviced food outlets (p < 0.001) and vending machines (p < 0.001). In 2021, green items were a higher proportion of available items (20.7%, n = 815) compared to 2017 (14.0%, n = 371), as were amber items (49.8%, n = 1957) compared to 2017 (29.2%, n = 775). Fewer items were classified as red in 2021 (29.4%, n = 1156) than in 2017 (56.8%, n = 1506). Mixed dishes were the most prevalent green items in both years, representing 11.4% (n = 446) of all items in 2021 and 5.5% (n = 145) in 2017. Fewer red packaged snacks (11.6%, n = 457 vs 22.5%, n = 598) and red cold drinks (5.2%, n = 205 vs 12.5%, n = 331) were available in 2021 compared to 2017. However, at either time, no organisation or setting met the criteria for alignment with the Policy (≥ 55% green items, 0% red items). CONCLUSIONS: Introduction of the Policy improved the relative healthiness of food and drinks available, but the proportion of red items remained high. More dedicated support is required to fully implement the Policy.

Platycodin D and voluntary running synergistically ameliorate memory deficits in 5 × FAD mice via mediating neuromodulation and neuroinflammation.

Introduction: Alzheimer's disease (AD) is the leading cause of dementia, and currently, no effective treatments are available to reverse or halt its progression in clinical practice. Although a plethora of studies have highlighted the benefits of physical exercise in combating AD, elder individuals often have limited exercise capacity. Therefore, mild physical exercise and nutritional interventions represent potential strategies for preventing and mitigating neurodegenerative diseases. Our research, along with other studies, have demonstrated that platycodin D (PD) or its metabolite, platycodigenin, derived from the medicinal plant Platycodon grandiflorus, exerts neuroprotective effects against amyloid ß (Aß)-induced neuroinflammation. However, the combined effects of PD and physical exercise on alleviating AD have yet to be explored. The current study aimed to investigate whether combined therapy could synergistically ameliorate memory deficits and AD pathology in 5 × FAD mice. Methods: Five-month-old 5 × FAD mice were randomly assigned to four groups, and received either PD (5 mg/kg/day, p.o.), voluntary running, or a combination of both for 47 days. Nest building test, locomotion test, and Morris water maze test were used to evaluate the cognitive function. Immunohistochemical and ELISA analysis was performed to determine Aß build-up, microglia and astrocytes hyperactivation, and survival neurons in the hippocampus and perirhinal cortex. Real-time quantitative PCR analysis was used to assess the polarization of microglia and astrocytes. HPLC analysis was performed to measure monoamine neurotransmitters in the hippocampus. Results and discussion: The combination of PD and voluntary running synergistically restored nest-building behavior, alleviated recognition and spatial memory deficits, and showed superior effects compared to monotherapy. In addition, the PD and voluntary running combination reduced Aß build-up, decreased hyperactivation of microglia and astrocytes in the hippocampus and perirhinal cortex, promoted the polarization of inflammatory M1 microglia and reactive astrocytes toward beneficial phenotypes, and lowered systemic circulating pro-inflammatory cytokines while increasing anti-inflammatory cytokines in 5 × FAD mice. Furthermore, combined therapy effectively protected neurons and increased levels of 5-hydroxytryptamine (5-HT) and dopamine (DA) in the hippocampus of 5 × FAD mice. In conclusion, the combination of PD and voluntary running holds great potential as a treatment for AD, offering promise for delaying onset or progression of AD.

Ethical challenges in qualitative sociology: a systematic literature review.

Qualitative researchers often encounter ethical challenges during their research process. Due to the large number of papers in which researchers reflect on specific and various ethical challenges within their projects, it proves difficult to keep track of them. To capture these reflexive practices, we conducted a literature review of 72 papers in sociology. Our review shows who reflects on research ethics and when and where such reflections occur. We identify 11 ethical issues that sociologists reflect on. Some issues address the challenges of implementing established ethical principles, such as (1) informed consent, (2) voluntary participation, (3) avoiding harm, (4) anonymization, and (5) confidentiality. Others go beyond these principles and refer to (6) the relationship between researchers and participants, (7) power asymmetries, (8) protecting yourself as a researcher, (9) deviant actions, (10) covert research, and (11) leaving the field. Our findings help researchers gain an overview of ethical challenges, enhancing their reflexivity.

Assessment of Knowledge, Attitude, Practice, and Associated Factors of Voluntary Blood Donation in Selected Towns of Awi Zone, Injibara, Ethiopia.

Background: Blood donation is the process of collecting blood from donors who are at low risk for infection and are unlikely to jeopardize their health by blood donation. It is a lifesaving practice for people who have lost ample volumes of blood as a result of accidents, obstetric and gynecological bleeding, severe anemia, and cancer. Aim: This study is aimed at assessing knowledge, attitude, practice, and associated factors toward voluntary blood donation in Chagni, Dangila, Injibara, and Jawi towns. Subject and Methods: A community-based cross-sectional study design and multistage sampling technique were employed. The data was analyzed using SPSS version 26. Both descriptive statistics and the multivariate logistic regression model were employed to determine the significance. The association between blood donation knowledge, attitude, practice, and sociodemographic variables was tested using multivariate logistic regression. Results: In Chagni, 110 (55.6%), Dangila, 162 (79.0%), Injibara, 139 (73.5%), and Jawi, 165 (64.5%), towns had adequate knowledge regarding voluntary blood donation. In Chagni, 141 (74.6%), Dangila, 170 (66.4%), Injibara, 168 (82.0%), and Jawi, 148 (74.7%), towns had an adequate attitude regarding voluntary blood donation. In Chagni, 28 (14.1%), Dangila (15.3%), Injibara (29.3%), and Jawi (12.3%), towns practiced voluntary blood donation. Respondents' sex, education level, and age were found to be significantly associated with knowledge, attitude, and practice of blood donation. Those who had a degree and above were more likely (AOR = 9.239, 5.789, 5.468, and 9.72 at 95% CI) to know about blood donation relative to those who could not read and write in Chagni, Dangila, Injibara, and Jawi, respectively. Conclusion: The majority of respondents had adequate knowledge and attitudes toward blood donation but had lower practices toward voluntary blood donation.

8-Week Kaempferia parviflora Extract Administration Improves Submaximal Exercise Capacity in Mice by Enhancing Skeletal Muscle Antioxidant Gene Expression and Plasma Antioxidant Capacity.

Black ginger (Kaempferia parviflora) extract (KPE) is extracted from a ginger family plant grown in Thailand. The polyphenolic components have potential antioxidant effects and have been reported to enhance exercise performance. However, the impact of long-term KPE administration combined with long-term training on the endurance exercise performance of healthy individuals has not been fully studied. In this study, a healthy mouse model was used to investigate the effects of 8 weeks KPE administration and voluntary wheel running on the submaximal endurance exercise capacity and its mechanism. The results showed that 8 weeks of KPE administration significantly enhanced the submaximal endurance exercise capacity of mice and extended the daily voluntary wheel running distance. By measuring oxidative stress markers in plasma and the mRNA expression of antioxidant genes in skeletal muscle, we found that KPE significantly increased plasma antioxidant levels and activated the Nrf2 (Nuclear factor erythroid 2-related factor 2)/ARE (Antioxidant Response Element) pathway and its downstream antioxidant genes expression in skeletal muscle. These results suggest that KPE may enhance the antioxidant capacity of plasma and skeletal muscle by activating the Nrf2-ARE-centered antioxidant pathway, thereby increasing the daily running distance and improving the submaximal endurance exercise capacity of mice.

The Effects of High-Intensity, Short-Duration and Low-Intensity, Long-Duration Hamstrings Static Stretching on Contralateral Limb Performance.

INTRODUCTION: Increases in contralateral range of motion (ROM) have been shown following acute high-intensity and high-duration static stretching (SS) with no significant change in contralateral force, power, and muscle activation. There are currently no studies comparing the effects of a high-intensity, short-duration (HISD) or low-intensity, long-duration (LILD) SS on contralateral performance. PURPOSE: The aim of this study was to examine how HISD and LILD SS of the dominant leg hamstrings influence contralateral limb performance. METHODS: Sixteen trained participants (eight females, eight males) completed three SS interventions of the dominant leg hamstrings; (1) HISD (6 × 10 s at maximal point of discomfort), (2) LILD (6 × 30 s at initial point of discomfort), and (3) control. Dominant and non-dominant ROM, maximal voluntary isometric contraction (MVIC) forces, muscle activation (electromyography (EMG)), and unilateral CMJ and DJ heights were recorded pre-test and 1 min post-test. RESULTS: There were no significant contralateral ROM or performance changes. Following the HISD condition, the post-test ROM for the stretched leg (110.6 ± 12.6°) exceeded the pre-test (106.0 ± 9.0°) by a small magnitude effect of 4.2% (p = 0.008, d = 0.42). With LILD, the stretched leg post-test (112.2 ± 16.5°) exceeded (2.6%, p = 0.06, d = 0.18) the pre-test ROM (109.3 ± 16.2°) by a non-significant, trivial magnitude. There were large magnitude impairments, evidenced by main effects for testing time for force, instantaneous strength, and associated EMG. A significant ROM interaction (p = 0.02) showed that with LILD, the stretched leg significantly (p = 0.05) exceeded the contralateral leg by 13.4% post-test. CONCLUSIONS: The results showing no significant increase in contralateral ROM with either HISD or LILD SS, suggesting the interventions may not have been effective in promoting crossover effects.

Comparing the effect of high-intensity interval exercise and voluntary exercise training on cognitive functions in rats.

It is known that exercise increases brain-derived neurotrophic factor (BDNF) levels in the hippocampus, the brain region responsible for learning and memory, resulting in improved cognitive functions and learning processes. However, it is claimed that different types of exercise cause different responses in the brain. It is thought that lactate and osteocalcin secreted in response to exercise are associated with an increase in BDNF levels. However, there are not enough studies on this subject. This study aimed to compare the effects of high-intensity interval training (HIIT) and voluntary exercise training on cognitive performance and molecular connections. Male rats were randomly divided into control, voluntary exercise training and HIIT groups. The voluntary exercise group had free access to the voluntary wheel for 8 weeks. The HIIT group performed HIIT on the treadmill 3 days a week for 8 weeks. The rats underwent open field (OF), elevated plus maze (EPM) and Morris water maze (MWM) tests 24 h after the last exercise training. Then, after blood was drawn under anesthesia, the rats were sacrificed and their hippocampus tissues were separated. Glucocorticoid and BDNF levels in the blood were evaluated by enzyme-linked immunosorbent assay (ELISA), and osteocalcin and BDNF expressions in the hippocampus were evaluated by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR). Neither voluntary exercise training nor HIIT had any significant effect on behavioral parameters assessed by OF, EPM and MWM tests. However, BDNF expression in hippocampus tissue was higher in the HIIT group than in the control group. In addition, osteocalcin expression in hippocampus tissue was higher in the HIIT and voluntary exercise groups than in the control group. In conclusion, according to the findings we obtained from this study, although it does not have a significant effect on cognitive functions, the effect of HIIT on brain functions seems to be more effective than voluntary exercise.

One respiratory cycle as a minimum time unit for making behavioral decisions in the mammalian olfactory system.

Voluntary behaviors such as sniffing, moving, and eating require decision-making accompanied by intentional respiration. Based on the study of respiration-coherent activity of rodent olfactory networks, we infer that during the inhalation phase of respiration, olfactory cortical areas process environmental odor information and transmit it to the higher multisensory cognitive areas via feedforward pathways to comprehensively evaluate the surrounding situation. We also infer that during the exhalation phase, the higher multisensory areas generate cognitive-signals and transmit them not only to the behavioral output system but also back to the olfactory cortical areas. We presume that the cortical mechanism couples the intentional respiration with the voluntary behaviors. Thus, in one respiratory cycle, the mammalian brain may transmit and process sensory information to cognize and evaluate the multisensory image of the external world, leading to one behavioral decision and one emotional expression. In this perspective article, we propose that one respiratory cycle provides a minimum time unit for decision making during wakefulness.

Comparative Study of Different Respiratory Muscle Training Methods: Effects on Cardiopulmonary Indices and Athletic Performance in Elite Short-Track Speedskaters.

Respiratory muscle training (RMT) improves endurance performance, balance, and ability to repeat high-intensity exercise bouts, providing a rationale to be applied in short-track speedskating. To establish a preferable RMT method for short-track speedskating, the influence of inspiratory pressure threshold loading (IPTL) and voluntary isocapnic hyperpnoea (VIH) on cardiopulmonary indices and athletic performance was investigated. Sixteen elite short-track speedskaters completed 6 weeks of RMT based on IPTL or VIH. Wingate Anaerobic Tests (WAnTs), cardiopulmonary exercise tests (CPETs), spirometry assessments, and on-ice time trials were performed before and after RMT intervention. Repeated measures ANOVA was used to assess the differences between each method's influence. No statistically significant (p > 0.05) differences between RMT methods were found in performance during the WAnT, CPET, or specific on-ice time trials. Spirometry measures were similar between both methods. Significant effects were found for the interaction between maximum breathing frequency during CPET (BFmax) and method (p = 0.009), as well as for the interaction between BFMax, method, and sex (p = 0.040). BFmax decreased for IPTL and increased for VIH. The interaction between method and sex revealed that BFmax increased only in males performing VIH. Our findings suggest that IPTL and VIH lead to analogous effects in the study participants, highlighting a negligible practical disparity in the impact of different RMT methods in elite short-track speedskaters.

Investigating Drivers Impacting Carbon Stock and Carbon Offset in a Large-Scale Rubber Plantation in the Middle South of Thailand.

A large-scale rubber plantation in Southern Thailand is expected to capture a significant amount of carbon dioxide from emissions through carbon sinks in the vegetation and soil. The goal of this research is to create a carbon offset assessment for rubber plantations lasting for 30 years using a voluntary market contract approach. To evaluate the area of large-scale rubber plantations, this study evaluated major growing regions in five provinces in the middle-south region of Thailand (Nakhon Si Thammarat, Phatthalung, Songkhla, Satun and Trang) using an integrated RS-GIS technique that incorporated biomass allometric equations, soil series databases, and object-based classification. The classification of rubber plantation areas and the mapping of rubber stand ages were conducted to estimate the above-ground biomass of the rubber tree. Texture analysis was used in the rubber classification process, and normalised difference vegetation index (NDVI) was combined with texture analysis to separate vegetation areas from other land cover. Four groups of varying ages (1-6, 7-13, 14-20 and 21-30 years old) were evaluated for their capacity to generate carbon offsets. The equations of voluntary market contract revenue according to the contract method of the CCX were applied for this case study. This evaluation was used to estimate their annual value, total and net incomes in the carbon market price regarding the RGGI Allowance (RGA). Carbon offset income was then used to estimate the potential income (over a 30-year period) of the life of the contract. The results showed that the carbon stock potential of rubber plantations depended on the age of the trees and the soil carbon stock. The total carbon stock in the rubber plantations varied from 249.73 to 301.48 Mg C/ha (or equivalently 916.49 to 1,106.44 Mg CO2e/ha). Furthermore, the potential net income of the contract was estimated to be between USD5,378.32 and USD5,930.38 Mg CO2e/ha over a 30-year period according to the voluntary market contract revenue. These results suggest that the large agricultural land plot policy could create opportunities for carbon offsetting. The policy of large-scale rubber areas could be used as a tool and mechanism for farmers who are considering participating in carbon-crediting mechanisms. Then, farmers could use voluntary market contracts as a guide and foundation for their decision-making. The carbon offset credit strategy could assist Thailand in achieving its climate goals of transitioning to a low-carbon agriculture sector.

The acute effect of respiratory muscle training on cortisol, testosterone, and testosterone-to-cortisol ratio in well-trained triathletes - exploratory study.

The study investigated acute changes in cortisol (C) and testosterone (T) associated with a popular RMT method, voluntary isocapnic hyperpnoea (VIH), in well-trained triathletes. 19 athletes (7 females, 12 males) performed a VIH training session with pre- and post- serum C and T measurements. Repeated measures ANOVA was employed to analyze hormone changes during VIH, with additional time-sex interaction. Pearson correlation coefficient has been computed to identify the relationship between hormonal changes and age, anthropometric indices, respiratory muscle strength, and training experience. There was a statistically significant effect for C changes (F = 13.101, p = 0.002, ηp2 = 0.421, ω2 = 0.08). The C concentration was significantly lower after VIH (Mean Difference = -32.49 ± 39.13 nmol*L-1). No significant effects for T, T/C ratio, and time-sex interactions were observed (p > 0.05). Amongst many, significant correlations between the percentage of body fat and changes in C (r=-0.464, p=0.045), body mass and changes in T (r=0.516, p=0.024), height and changes in T (r=0.509, p=0.026) were found. VIH significantly lowered C concentration. No significant effects for T, T/C ratio, and no between-sex differences were observed. Noteworthy individual variability was observed in all the monitored indices. Significant correlations were found between acute hormone changes associated with VIH and selected anthropometric indices. The study provides initial insight into VIH's role in athletes' hormonal balance to possibly guide exercise prescription, autoregulation, arousal state management, and recovery practices in athletes.

"You just can't do that in dementia care": Barriers to partnership working within dementia services for people from south Asian communities.

Background: People from South Asian communities are under-represented at all levels of dementia services. Consequently, there is pressure for the statutory sector to deliver services in partnership with Voluntary, Community, Faith and Social Enterprises (VCFSEs). This study set out to explore the constraints to effective partnership working which prevent dementia care from being delivered in an equitable way.Methods: Data collection consisted of two phases. First, we interviewed seven people with experience of partnership working and developed three fictional vignettes that were representative of the challenges they faced. We then used these vignettes to stimulate discussion in focus groups and interviews with 13 VCFSE and 16 statutory sector participants. Data was analysed using deductive thematic analysis.Findings: Three themes were developed during the analysis. First, White British-centric services focused on the challenges for statutory services in meeting the needs of South Asians, developing flexible, responsive services and making inclusive partnership working truly meaningful. Second, VCFSE participants (but not statutory service participants) associated a failure to deliver effective partnership working with unconscious bias operating within systems, leading to the devaluing of their expertise and to their views being ignored. Finally, participants emphasised the need to prioritise relationships if they were to meet the challenges of developing partnership working.Conclusion: We identified three constraints acting to prevent effective partnership working. First, the different meanings that statutory and VCFSE participants attach to challenges threatens their ability to develop a shared understanding of the needs of communities. Second, a reluctance to explicitly address service deficiencies can mean that stereotypes remain unaddressed. Finally, while both parties lacked power to change the fundamentals of service delivery, power and resources were also unbalanced with VCSFE services being more reliant on the statutory sector.

Analysis of Blood Donor Deferral Pattern at a Tertiary Care Hospital in Chennai: A Cross-Sectional Retrospective Study.

Background Blood is essential for saving lives, particularly in emergencies. However, many patients, especially in developing countries face delays in accessing safe blood due to inadequate infrastructure, insufficient blood banks, poorly equipped laboratories, unreliable transportation systems, low donation rates driven by cultural beliefs, fear, and misconceptions, poor blood donor recruitment and retention, economic constraints, and a general lack of awareness and education about blood donation. Ensuring safe transfusions requires advanced technology and promoting healthy, voluntary donations. Donor selection is crucial for safety, preventing adverse reactions through proper criteria and infection screenings. Donor deferrals can discourage donors and hinder recruitment, so identifying and addressing deferral causes is vital. Blood centers must balance quality and quantity by using thorough donor assessments. Efforts should focus on both recruiting new donors and retaining deferred ones to ensure a stable blood supply. Aim The aim of the study is to evaluate and analyze the patterns and causes of blood donor deferrals in a tertiary care hospital. The objectives are to determine the incidence and reasons for blood donor deferrals. Materials and methods A cross-sectional retrospective study was conducted for 36 months from May 2021 to May 2024. A simple random sampling method was used to select the blood donors who reported for donation. Data was obtained from records maintained by the blood center. Descriptive statistics were utilized to summarize the demographics of the blood donors, including deferral rates among males and females, and the frequency of temporary and permanent deferrals. A Chi-square test was done to find the association between gender and deferral rates in blood donation. This analysis aimed to explore gender variations and underlying health status differences between male and female donors, as these can influence deferral rates. Results From May 2021 to May 2024, 17,082 people registered to donate blood at the Blood Centre, Department of Transfusion Medicine. Out of these, 1,000 donors, or 5.85%, were deferred. The majority of donors were males 16,638, with only 444 females. Most deferrals (76.4%) were temporary, often due to low hemoglobin levels or recent alcohol intake. Permanent deferrals (23.6%) were usually due to uncontrolled hypertension and diabetes. A significant association was found between gender and type of deferral among participants (p < 0.05). Conclusion This cross-sectional retrospective study on blood donor deferral patterns in a tertiary care hospital highlights key reasons such as low hemoglobin, recent alcohol intake, hypertension, and diabetes. To improve donor eligibility and retention, targeted strategies including enhanced education and community engagement are essential. These efforts will strengthen blood transfusion services and support critical healthcare needs effectively.

The effect of caffeine chewing gum on muscle performance and fatigue after severe-intensity exercise: isometric vs. dynamic assessments in trained cyclists.

This study investigated the effect of caffeinated chewing gum (GUMCAF) on muscle fatigue (isometric vs. dynamic) after severe-intensity cycling bouts. Fifteen trained male cyclists participated in four visits. Each visit involved two severe-intensity cycling bouts (Δ1 and Δ2) lasting 6 min, separated by a 5-min recovery period. Muscle fatigue was assessed by isometric maximal voluntary knee extension contraction (IMVC) with twitch interpolation technique and dynamically by 7 s all-out cycling sprints. Assessments were performed before GUMCAF (Pre-GUM) and after the cycling bouts (Post-Exercise). GUMCAF and placebo gum (GUMPLA) were administered in a randomized double-blind procedure with participants receiving each gum type (GUMCAF and GUMPLA) during two separate visits. The results showed no significant interaction between gum types and time for the isometric and dynamic measurements (p > 0.05). The percentage change in performance from Pre-GUM to Post-Exercise showed no significant difference between GUMCAF and GUMPLA for either the dynamic-derived TMAX (~ -17.8% and -15.1%, respectively; p = 0.551) or isometric IMVC (~ -12.3% and -17.7%, respectively; p = 0.091) measurements. Moderate to large correlations (r = 0.31-0.51) were found between changes in sprint maximal torque and maximal power output measurements and isometric force, for both gum conditions. GUMCAF was not effective in attenuating muscle force decline triggered by severe-intensity cycling exercises, as measured by both isometric and dynamic methods. The correlations between IMVC and cycling maximal torque and power output suggest caution when interpreting isometric force as a direct measure of fatigue during dynamic cycling exercises.