Routine use of cell salvage during cesarean section: A practice evaluation.

INTRODUCTION: Intraoperative cell salvage is a well-documented alternative to donor blood transfusion given the scarcity of donor blood pools and the incumbent risk of allogenic blood transfusion. Its use in obstetrics has been limited by concern over fetal alloimmunization due to the risk of fetomaternal hemorrhage. However, there are a paucity of studies reporting on outcome. The aim of this study was to report on a four-year experience of routine use of intraoperative cell salvage and the impact on subsequent pregnancy outcomes. MATERIAL AND METHODS: This was a tertiary center retrospective service evaluation cohort study and included all women undergoing cesarean section between December 2014 and November 2018 in a tertiary obstetric unit, identifying women who had reinfusion of intraoperative cell salvage. Data regarding index pregnancy as well as subsequent pregnancies at the hospital were extracted from hospital electronic records. Subsequent pregnancy outcome and maternal antibody status in that pregnancy were collected up until November 2022. RESULTS: During the study period, 6656 cesarean sections were performed, with 436 (6.6%) receiving reinfusion of salvaged blood. The mean volume of reinfused blood was 396 mL. A total of 49 (0.7%) women received donor blood transfusion. Of those who received reinfusion of salvaged blood, 79 (18.1%) women had subsequent pregnancies over the eight-year follow-up period. There was one case (0.23%) of fetal cell alloimmunization demonstrated by the presence of anti-D antibodies on the subsequent pregnancy booking bloods. CONCLUSIONS: Routine intraoperative cell salvage may be used to reduce the need for blood transfusion during cesarean section. The risk of fetal cell alloimmunization in a future pregnancy following reinfusion of intraoperative cell salvage is one in 436. Given an apparent small risk of fetal cell alloimmunization, further work is required to establish the safety profile of intraoperative cell salvage in pregnancy.

Dissemination of Registered COVID-19 Clinical Trials (DIRECCT): a cross-sectional study.

BACKGROUND: The results of clinical trials should be completely and rapidly reported during public health emergencies such as COVID-19. This study aimed to examine when, and where, the results of COVID-19 clinical trials were disseminated throughout the first 18 months of the pandemic. METHODS: Clinical trials for COVID-19 treatment or prevention were identified from the WHO ICTRP database. All interventional trials with a registered completion date ≤ 30 June 2021 were included. Trial results, published as preprints, journal articles, or registry results, were located using automated and manual techniques across PubMed, Google Scholar, Google, EuropePMC, CORD-19, the Cochrane COVID-19 Study Register, and clinical trial registries. Our main analysis reports the rate of dissemination overall and per route, and the time from registered completion to results using Kaplan-Meier methods, with additional subgroup and sensitivity analyses reported. RESULTS: Overall, 1643 trials with completion dates ranging from 46 to 561 days prior to the start of results searches were included. The cumulative probability of reporting was 12.5% at 3 months from completion, 21.6% at 6 months, and 32.8% at 12 months. Trial results were most commonly disseminated in journals (n = 278 trials, 69.2%); preprints were available for 194 trials (48.3%), 86 (44.3%) of which converted to a full journal article. Trials completed earlier in the pandemic were reported more rapidly than those later in the pandemic, and those involving ivermectin were more rapidly reported than other common interventions. Results were robust to various sensitivity analyses except when considering only trials in a "completed" status on the registry, which substantially increased reporting rates. Poor trial registry data on completion status and dates limits the precision of estimates. CONCLUSIONS: COVID-19 trials saw marginal increases in reporting rates compared to standard practice; most registered trials failed to meet even the 12-month non-pandemic standard. Preprints were common, complementing journal publication; however, registries were underutilized for rapid reporting. Maintaining registry data enables accurate representation of clinical research; failing to do so undermines these registries' use for public accountability and analysis. Addressing rapid reporting and registry data quality must be emphasized at global, national, and institutional levels.

Effect of Work: Rest Ratio on Cycling Performance Following Sprint Interval Training: A Randomized Control Trial.

Lloyd Jones, MC, Morris, MG, and Jakeman, JR. Effect of work: Rest ratio on cycling performance following sprint interval training: A randomized control trial. J Strength Cond Res 33(12): 3263-3268, 2019-Sprint interval training (SIT) has been shown to improve performance measures in a range of individuals, and it is understood that different responses can be elicited from different training protocols. However, consideration of changes in work to rest ratios could offer important insight into optimizing training programs. The purpose of this study was to investigate the effect of 3 different work to rest ratios on exercise performance. Thirty-six male and female subjects were randomly allocated to 1 of 3 training groups or a nontraining control group. Training consisted of 10 × 6 second "all-out" sprints on a cycle ergometer, with a 1:8, 1:10, or 1:12 work-to-rest ratio. Performance data, including peak power output, performance decrement, and 10-km time trial performance data were collected before and after 2 weeks of SIT. There were significant (p ≤ 0.05) improvements in all parameters for the training groups, but no changes were observed in the control condition. Peak power increased by 57.2, 50.7, and 53.7 W in the 1:8, 1:10 and 1:12 groups, respectively, with no significant differences in response between conditions. Time trial performance improved significantly in all 3 training conditions (29.4, 8.7, and 25.1 seconds in the 1:8, 1:10, and 1:12 groups), while worsening in the control group. All training conditions resulted in significant improvements in performance, but there were no significant differences in improvement for any of the groups. Any of the 3 stated that work to rest ratios would be appropriate for use with athletes and allow some level of personal preference for those interested in using the protocol.

Dietary glycaemic index and glycaemic load among Australian children and adolescents: results from the 2011-2012 Australian Health Survey.

This study aimed to examine the dietary glycaemic index (GI) and glycaemic load (GL) of Australian children and adolescents, as well as the major food groups contributing to GL, in the recent 2011-2012 Australian Health Survey. Plausible food intake data from 1876 children and adolescents (51 % boys), collected using a multiple-pass 24-h recall, were analysed. The GI of foods was assigned based on a step-wise published method using values from common GI databases. Descriptive statistics were calculated for dietary GI, GL and contribution to GL by food groups, stratified by age group and sex. Linear regression was used to test for trends across age groups for BMI, dietary GI and GL, and intakes of energy, nutrients and food groups. Pearson's χ 2 test was used to test for differences between age groups for categorical subject characteristic variables. Mean dietary GI and GL of participants were 55·5 (sd 5·3) and 137·4 (sd 50·8), respectively. The main contributors to dietary GL were starchy foods: breads, cereal-based dishes, breakfast cereals, flours, grains and potatoes accounted for 41 % of total GL. Sweetened beverages, fruit and vegetable juices/drinks, cake-type desserts and sweet biscuits contributed 15 %. No significant difference (at P<0·001) was observed between sexes. In conclusion, Australian children and adolescents appear to consume diets with a lower GI than European children. Exchanging high-GI foods for low-GI alternatives within core and non-core foods may improve diet quality of Australian children and adolescents.

Use and efficacy of nebulized naloxone in patients with suspected opioid intoxication.

OBJECTIVE: To describe the use and efficacy of nebulized naloxone in patients with suspected opioid intoxication. METHODS: This was an observational study conducted at an inner city emergency department. Patients were eligible if they had self-reported or suspected opioid intoxication and a spontaneous respiratory rate ≥6 breaths/minute. Nebulized naloxone (2 mg in 3 mL normal saline) was administered through a standard face mask at the discretion of the treating physician. Structured data collection included demographics, vital signs pre and post naloxone administration and adverse events. The primary outcome was level of consciousness, which was recorded pre and 15 minutes postnaloxone administration using the Glasgow Coma Scale (GCS) and the Richmond Agitation Sedation Scale (RASS). RESULTS: Of the 73 patients who presented with suspected opioid intoxication and were given naloxone over the study period, 26 were initially treated with nebulized naloxone. After nebulized naloxone administration, median GCS improved from 11 [interquartile range (IQR) 3.5] to 13 (IQR, 2.5), P = .001. Median RASS improved from -3.0 (IQR, -1.0) to -2.0 (IQR, -1.5), P < .0001. Need for supplemental oxygen decreased from 81% to 50%, P = .03. Vital signs did not differ pre/post therapy. There were few adverse effects from nebulized naloxone administration: 12% experienced moderate-severe agitation, 8% were diaphoretic and none vomited. Eleven required subsequent administrations of naloxone, nine of whom self-reported using either heroin, methadone or both. Of these, 5 underwent urine drug screening and all 5 tested positive for either opiates or methadone. CONCLUSIONS: Nebulized naloxone was well-tolerated and led to a reduction in the need for supplemental oxygen as well as improved median GCS and RASS scores in patients with suspected opioid intoxication.

Optimizing outcomes in psilocybin therapy: Considerations in participant evaluation and preparation.

Recent studies have demonstrated the promise of psilocybin therapies in creating positive changes for those with poor mental health across multiple diagnostic categories, including major depressive disorder (MDD), end-of-life anxiety, and obsessive-compulsive disorder (OCD). While there may be a large population that is eligible to participate in psilocybin therapy based on psychiatric diagnosis and medical clearance, little attention has been given to intrapersonal and interpersonal factors that might influence patient's readiness (i.e., eligibility and capacity) for psychedelic interventions. This paper proposes that readiness assessment includes both intrapersonal and interpersonal factors in order to improve safety, patient care, and treatment outcomes. While at the present time a reliable and valid instrument has not been developed, we propose that three specific areas of focus - patient presentation, therapeutic alliance, and patient safety - may be used to establish a patient's readiness for psilocybin therapy, thus increasing therapy optimization and personalization.

Single-dose psilocybin for a treatment-resistant episode of major depression: Impact on patient-reported depression severity, anxiety, function, and quality of life.

BACKGROUND: COMP360 is a proprietary, synthetic formulation of psilocybin being developed for treatment-resistant depression (TRD), a burdensome, life-threatening illness with high global impact. Here, we expand upon the previous report of primary outcomes from a phase 2 study of COMP360 in individuals with TRD-the largest randomised controlled clinical trial of psilocybin-to discuss findings of the exploratory efficacy endpoints. METHODS: In this phase 2, double-blind trial, 233 participants with TRD were randomised to receive a single dose of psilocybin 25 mg, 10 mg, or 1 mg (control), administered alongside psychological support from trained therapists. Efficacy measures assessed patient-reported depression severity, anxiety, positive and negative affect, functioning and associated disability, quality of life, and cognitive function. RESULTS: At Week 3, psilocybin 25 mg, compared with 1 mg, was associated with greater improvements from Baseline total scores in all measures. The 10 mg dose produced smaller effects across these measures. LIMITATIONS: Interpretation of this trial is limited by the absence of an active comparator and the possibility of functional unblinding in participants who received a low dose of psilocybin. CONCLUSIONS: Three weeks after dosing, psilocybin 25 mg and, to a lesser degree, 10 mg improved measures of patient-reported depression severity, anxiety, affect, and functioning. These results extend the primary findings from the largest randomised clinical trial of psilocybin for TRD to examine other outcomes that are of importance to patients.

The effects of psilocybin on cognitive and emotional functions in healthy participants: Results from a phase 1, randomised, placebo-controlled trial involving simultaneous psilocybin administration and preparation.

BACKGROUND: Psilocybin, a psychoactive serotonin receptor partial agonist, has been reported to acutely reduce clinical symptoms of depressive disorders. Psilocybin's effects on cognitive function have not been widely or systematically studied. AIM: The aim of this study was to explore the safety of simultaneous administration of psilocybin to healthy participants in the largest randomised controlled trial of psilocybin to date. Primary and secondary endpoints assessed the short- and longer-term change in cognitive functioning, as assessed by a Cambridge Neuropsychological Test Automated Battery (CANTAB) Panel, and emotional processing scales. Safety was assessed via endpoints which included cognitive function, assessed by CANTAB global composite score, and treatment-emergent adverse event (TEAE) monitoring. METHODS: In this phase 1, randomised, double-blind, placebo-controlled study, healthy participants (n = 89; mean age 36.1 years; 41 females, 48 males) were randomised to receive a single oral dose of 10 or 25 mg psilocybin, or placebo, administered simultaneously to up to six participants, with one-to-one psychological support - each participant having an assigned, dedicated therapist available throughout the session. RESULTS: In total, 511 TEAEs were reported, with a median duration of 1.0 day; 67% of all TEAEs started and resolved on the day of administration. There were no serious TEAEs, and none led to study withdrawal. There were no clinically relevant between-group differences in CANTAB global composite score, CANTAB cognitive domain scores, or emotional processing scale scores. CONCLUSIONS: These results indicate that 10 mg and 25 mg doses of psilocybin were generally well tolerated when given to up to six participants simultaneously and did not have any detrimental short- or long-term effects on cognitive functioning or emotional processing. CLINICAL TRIAL REGISTRATION: EudraCT (https://www.clinicaltrialsregister.eu/) number: 2018-000978-30.

Patient perceptions of computed tomographic imaging and their understanding of radiation risk and exposure.

STUDY OBJECTIVE: We describe patient perceptions of computed tomography (CT) and their understanding of radiation exposure and risk. METHODS: This was a cross-sectional study of acute abdominal pain patients aged 18 years or older. Confidence in medical evaluations with increasing levels of laboratory testing and imaging was rated on a 100-point visual analog scale. Knowledge of radiation exposure was ascertained when participants compared the radiation dose of one abdomen-pelvis CT with 2-view chest radiography. To assess cancer risk knowledge, participants rated their agreement with these factual statements: "Approximately 2 to 3 abdominal CTs give the same radiation exposure as experienced by Hiroshima survivors" and "2 to 3 abdominal CTs over a person's lifetime can increase cancer risk." Previous CT was also assessed. RESULTS: There were 1,168 participants, 67% women and mean age 40.7 years (SD 15.9 years). Median confidence in a medical evaluation without ancillary testing was 20 (95% confidence interval [CI] 16 to 25) compared with 90 (95% CI 88 to 91) when laboratory testing and CT were included. More than 70% of participants underestimated the radiation dose of CT relative to chest radiography, and cancer risk comprehension was poor. Median agreement with the Hiroshima statement was 13 (95% CI 10 to 16) and 45 (95% CI 40 to 45) with the increased lifetime cancer risk statement. Seven hundred ninety-five patients reported receiving a previous CT. Of 365 patients who reported no previous CT, 142 (39%) had one documented in our electronic medical record. CONCLUSION: Patients are more confident when CT imaging is part of their medical evaluation but have a poor understanding of the concomitant radiation exposure and risk and underestimate their previous imaging experience.

Sex bias in cardiovascular testing: the contribution of patient preference.

STUDY OBJECTIVE: Women with potential acute coronary syndromes are less likely to receive cardiac catheterization or revascularization than men. We hypothesize that this may be due to different diagnostic test preferences of female and male patients. METHODS: We conducted a cohort study at 4 emergency departments enrolling patients who presented with symptoms of potential acute coronary syndromes. After hearing the potential benefits and harms of each test, subjects completed a 21-item survey assessing their preference for noninvasive testing versus cardiac catheterization. Based on hypothetical test results, similar questions about medical versus interventional management were asked. Subjects were also queried about likelihood of following physician recommendation for each test or intervention. Actual 30-day testing and interventions were recorded. The main outcome was patient preference about each procedure and the likelihood of patient saying they would accept the physician recommendation. RESULTS: One thousand eighty patients enrolled; 652 (60%) were admitted to the hospital. With regard to diagnostic test preference, both women and men preferred stress test to catheterization (women 58% versus men 52%; difference 6% [95% confidence interval {CI} -0.06% to 12%]), and the proportion of women and men who would accept the physician recommendation for stress tests was similar (85% for both); however, the stated acceptance rate for cardiac catheterization was lower for women (65% versus 75%; difference -10% [95% CI -15% to -4%]). Women were 6% less likely (67% versus 73%; 95% CI for difference 12% to 0.5%) to accept percutaneous coronary intervention over medical therapy and 7% less likely (61% versus 68%; 95% CI for difference -13% to 1%) to desire coronary artery bypass grafting over medical therapy. The survey results are consistent with the patients' clinical course. During the initial hospitalization, women were less likely to receive diagnostic testing of any type (38% versus 45%; difference -7%; 95% CI for the difference -13% to -1.5%) and cardiac catheterization (10% versus 17%; difference -7% [95% CI -11% to -2%]). Revascularization was infrequent in both groups (4% versus 6%; difference -2% [95% CI -5% to 0.6%]). CONCLUSION: Although women and men had similar preferences about cardiac diagnostic tests and treatment options, women were less likely than men to say they would accept the physician recommendation for any intervention. Patient preference may partially explain the disparity in cardiovascular testing between women and men.

Results availability and timeliness of registered COVID-19 clinical trials: interim cross-sectional results from the DIRECCT study.

OBJECTIVE: To examine how and when the results of COVID-19 clinical trials are disseminated. DESIGN: Cross-sectional study. SETTING: The COVID-19 clinical trial landscape. PARTICIPANTS: 285 registered interventional clinical trials for the treatment and prevention of COVID-19 completed by 30 June 2020. MAIN OUTCOME MEASURES: Overall reporting and reporting by dissemination route (ie, by journal article, preprint or results on a registry); time to reporting by dissemination route. RESULTS: Following automated and manual searches of the COVID-19 literature, we located 41 trials (14%) with results spread across 47 individual results publications published by 15 August 2020. The most common dissemination route was preprints (n=25) followed by journal articles (n=18), and results on a registry (n=2). Of these, four trials were available as both a preprint and journal publication. The cumulative incidence of any reporting surpassed 20% at 119 days from completion. Sensitivity analyses using alternate dates and definitions of results did not appreciably change the reporting percentage. Expanding minimum follow-up time to 3 months increased the overall reporting percentage to 19%. CONCLUSION: COVID-19 trials completed during the first 6 months of the pandemic did not consistently yield rapid results in the literature or on clinical trial registries. Our findings suggest that the COVID-19 response may be seeing quicker results disclosure compared with non-emergency conditions. Issues with the reliability and timeliness of trial registration data may impact our estimates. Ensuring registry data are accurate should be a priority for the research community during a pandemic. Data collection is underway for the next phase of the DIssemination of REgistered COVID-19 Clinical Trials study expanding both our trial population and follow-up time.

Making a COVID-19 vaccine that works for everyone: ensuring equity and inclusivity in clinical trials.

Coronavirus disease 2019 (COVID-19) mortality and morbidity have been shown to increase with deprivation and impact non-White ethnicities more severely. Despite the extra risk Black, Asian and Minority Ethnicity (BAME) groups face in the pandemic, our current medical research system seems to prioritise innovation aimed at people of European descent. We found significant difficulties in assessing baseline demographics in clinical trials for COVID-19 vaccines, displaying a lack of transparency in reporting. Further, we found that most of these trials take place in high-income countries, with only 25 of 219 trials (11.4%) taking place in lower middle- or low-income countries. Trials for the current best vaccine candidates (BNT162b2, ChadOx1, mRNA-173) recruited 80.0% White participants. Underrepresentation of BAME groups in medical research will perpetuate historical distrust in healthcare processes, and poses a risk of unknown differences in efficacy and safety of these vaccines by phenotype. Limiting trial demographics and settings will mean a lack of global applicability of the results of COVID-19 vaccine trials, which will slow progress towards ending the pandemic.

Development and Evaluation of a Therapist Training Program for Psilocybin Therapy for Treatment-Resistant Depression in Clinical Research.

Introduction: Psychological support throughout psilocybin therapy is mandated by regulators as an essential part of ensuring participants' physical and psychological safety. There is an increased need for specially trained therapists who can provide high-quality care to participants in clinical studies. This paper describes the development and practical implementation of a therapist training program of psychological support within a current phase IIb international, multicenter, randomized controlled study of psilocybin therapy for people experiencing treatment-resistant depression. Description of Training Program: This new and manualized approach, based on current evidence-based psychotherapeutic approaches, was developed in partnership with different mental health researchers, practitioners, and experts; and has been approved by the FDA. Training consists of four components: an online learning platform; in-person training; applied clinical training; and ongoing individual mentoring and participation in webinars.This paper provides a brief overview of the method of support, the rationale and methodology of the training program, and describes each stage of training. The design and implementation of fidelity procedures are also outlined. Lessons Learned: As part of the phase IIb study of psilocybin therapy for treatment-resistant depression, 65 health care professionals have been fully trained as therapists and assisting therapists, across the US, Canada and Europe. Therapists provided informal feedback on the training program. Feedback indicates that the didactic and experiential interactive learning, delivered through a combination of online and in-person teaching, helped therapists build conceptual understanding and skill development in the therapeutic approach. Clinical training and engagement in participant care, under the guidance of experienced therapists, were considered the most beneficial and challenging aspects of the training. Conclusions: Clinical training for therapists is essential for ensuring consistently high-quality psilocybin therapy. Development of a rigorous, effective and scalable training methodology has been possible through a process of early, active and ongoing collaborations between mental health experts. To maximize impact and meet phase III and post-approval need, enhanced online learning and establishing pathways for clinical training are identified as critical points for quality assurance. This will require close public, academic and industry collaboration.

Vibrational characteristics of Balinese gamelan metallophones.

A study of the eight metallophone pairs from a Balinese gamelan semara dana has been conducted. Acoustical recordings of metallophone bars being struck were used to examine ratios of overtone frequencies to the fundamental. Results showed large variability in the number and ratios of overtones present. Scanning laser Doppler vibrometry measurements made on several bars also revealed great variability in mode shapes present. The distribution of prominent overtones and their modal shapes do not appear to match those of Western metallophones. Notably, the overall gamelan metallophone characteristics are quite dissimilar to the glockenspiel, which disagrees with previous studies.

Simulation modelling of patient flow and capacity planning for regional long-term care needs: a case study.

The need for Long-Term Care (LTC) arises in the elderly population, especially those reaching age 65 each year. This elderly population will grow tremendously in the United States over the next decade, resulting in short- and long-term challenges of matching resource capacity with uncertain demand for hospitals and other healthcare providers. This paper describes research involving the development of a simulation model of patient flow in order to understand the relationship between capacity and demand, and to investigate the impacts on performance measures such as average wait times for LTC patients. We propose an aggregate capacity model to consider patient flow among various types of care providers by integrating hospitals, nursing homes, assisted living facilities, and home health care. Using the data including patient demographics and service provider information, we forecast patient demand for LTC. The computational results demonstrate the efficacy of a simulation-based optimisation solution approach for capacity planning.

Impact of time and work:rest ratio matched sprint interval training programmes on performance: A randomised controlled trial.

OBJECTIVES: The aim of this study was to examine the effects of a short training intervention using two repeated sprint protocols matched for total sprint duration and work:rest ratio. DESIGN: Randomised-controlled trial. METHODS: Thirty physically active males were randomly allocated to one of two sprint training groups: a 6s group, a 30s group or a non-exercising control. The training groups were matched for work:rest ratio and total sprint time per session, and completed 6 training sessions over a 2-week period. Before and after the 2 week training period, participants completed a VO2max test and a 10km time trial on a cycle ergometer. RESULTS: Time trial performance increased significantly by 5.1% in 6s (630±115s to 598±92s; p<0.05) and 6.2% in 30s (579±68s to 543±85s; p<0.05) from baseline testing, but there was no significant change in the control group (p>0.05), and no significant difference between exercise groups (p>0.05). The 6s group increased peak power output by 9.0% (from 1092±263W to 1181±248W; p<0.05) from sprint session 1 to 6, and the 30s group by 20.0% (1041±161W to 1237±159W; p<0.05). CONCLUSIONS: This study indicates that both 6 and 30s bouts of repeated sprint exercise, matched for total sprint duration and W:R can improve athletic performance.

What Is the Relationship Between Dairy Intake and Blood Pressure in Black and White Children and Adolescents Enrolled in a Weight Management Program?

BACKGROUND: The DASH (Dietary Approaches to Stop Hypertension) clinical trials and other studies have demonstrated a relationship between diet and cardiovascular outcomes in adults, yet little is known of this relationship in children. Childhood obesity has reached epidemic proportions in the United States, with similar increases in hypertension among this population. The purpose of our study was to examine the association between dairy intake and blood pressure (BP) in a cohort of children and adolescents (aged 4-17 years) enrolled in a weight management program. METHODS AND RESULTS: Dietary intake was assessed using the Block Kids 2004 food frequency questionnaire in a cross-sectional sample of participants enrolled in the Pediatric Metabolic Syndrome Study at the Children's Hospital (Charleston, SC). BP and other anthropometrics were obtained at baseline. Only children with complete baseline data and food frequency questionnaires were included in this analysis (n=117). Associations between food group/nutrient intake and BP were examined across race and sex using ANOVA and Pearson correlations. Linear regression models were controlled for body mass index and age. In the total sample, a significant inverse relationship was found between the intake of dairy and systolic BP (r=-0.24, P=0.009). The effect of dairy on systolic BP, however, differed by race. We observed a decrease of 11.2 mm Hg for each serving of dairy consumed by white children, and no decrease in systolic BP in black children (P=0.001 for the race-dairy serving interaction). CONCLUSIONS: Nutrition professionals must consider nonnutrition factors contributing to childhood hypertension, as current dietary recommendations appear to have differential outcomes across races.

Dietary glycaemic index and glycaemic load among Australian adults - results from the 2011-2012 Australian Health Survey.

This study aimed to determine the major food groups contributing to dietary glycaemic load (GL). Plausible food intake data collected using a multiple-pass 24 hour recall from a weighted sample of 6326 adult respondents (52% male) of the 2011-2012 Australian Health Survey dataset (AHS) were analysed. The GI of foods was estimated based on a previously published step-wise method. Descriptive statistics were calculated for dietary glycaemic index (GI), GL and contribution to GL by major food groups, stratified by age and sex. Trends across age groups were assessed using linear regression. Pearson's χ2 was used to test for differences between age groups for categorical demographics variables. The mean (SD) dietary GI and GL was 54 (7) and 135 (59) respectively and the top 3 contributors to dietary GL were breads (14.4%), cereal-based dishes (10.3%) and breakfast cereals (ready to eat) (6.6%). There were small but significant differences in the GL contribution pattern between the sexes. The findings indicate that the average dietary GI of Australian adults is similar to that of other population groups, with a large proportion of starchy and energy-dense nutrient-poor foods that contribute to a high GL.

The National Institute for Health Research at 10 Years: An Impact Synthesis: 100 Impact Case Studies.

The National Institute for Health Research (NIHR) funds and supports world-leading clinical and applied health and social care research, as well as research infrastructure in the NHS. Providing £1 billion of funding each year, NIHR aims to: drive the faster translation of new treatments, technologies and diagnostics to improve outcomes for health and care services; promote the wealth of the nation, including via inward investment from the health research community; pull basic science discoveries through into tangible benefits for patients and the public; and provide research evidence to support more effective and cost-effective NHS delivery. To mark its tenth anniversary, the Department of Health commissioned the Policy Research in Science and Medicine unit to consider the question: "What are the ways in which NIHR has benefited the health research landscape in the past ten years?" This study identifies and celebrates 100 examples of positive change resulting from NIHR's support of research. A synthesis of 100 case studies is provided, which highlights the benefits and wider impacts of research, capacity building, and other activities undertaken with NIHR's support since its creation in 2006. The study concludes with a reflection of how the NIHR has transformed R&D in and for the NHS and wider health service, and the people they serve. The study draws together---for the first time---examples of the breadth of NIHR's impacts in a single resource. It will be of interest to healthcare professionals involved in research, academics working in health and social care, and members of the public wishing to understand the value of research in the NHS and the wider health and care system.