Challenges and opportunities for educating health professionals after the COVID-19 pandemic.

The education of health professionals substantially changed before, during, and after the COVID-19 pandemic. A 2010 Lancet Commission examined the 100-year history of health-professional education, beginning with the 1910 Flexner report. Since the publication of the Lancet Commission, several transformative developments have happened, including in competency-based education, interprofessional education, and the large-scale application of information technology to education. Although the COVID-19 pandemic did not initiate these developments, it increased their implementation, and they are likely to have a long-term effect on health-professional education. They converge with other societal changes, such as globalisation of health care and increasing concerns of health disparities across the world, that were exacerbated by the pandemic. In this Health Policy, we list institutional and instructional reforms to assess what has happened to health-professional education since the publication of the Lancet Commission and how the COVID-19 pandemic altered the education process.

Appetite and energy intake responses to breakfast consumption and carbohydrate supplementation in hypoxia.

PURPOSE: The purpose of experiment one was to determine the appetite, acylated ghrelin and energy intake response to breakfast consumption and omission in hypoxia and normoxia. Experiment two aimed to determine the appetite, acylated ghrelin and energy intake response to carbohydrate supplementation after both breakfast consumption and omission in hypoxia. METHODS: In experiment one, twelve participants rested and exercised once after breakfast consumption and once after omission in normobaric hypoxia (4300 m: FiO2 ~11.7%) and normoxia. In experiment two, eleven participants rested and exercised in normobaric hypoxia (4300 m: FiO2 ~11.7%), twice after consuming a high carbohydrate breakfast and twice after breakfast omission. Participants consumed both a carbohydrate (1.2g·min-1 glucose) and a placebo beverage after breakfast consumption and omission. Measures of appetite perceptions and acylated ghrelin were taken at regular intervals throughout both experiments and an ad-libitum meal was provided post-exercise to quantify energy intake. RESULTS: Breakfast consumption had no significant effect on post exercise energy intake or acylated ghrelin concentrations, despite reductions in appetite perceptions. As such, breakfast consumption increased total trial energy intake compared with breakfast omission in hypoxia (7136 ± 2047 kJ vs. 5412 ± 1652 kJ; p = 0.02) and normoxia (9276 ± 3058 vs. 6654 ± 2091 kJ; p < 0.01). Carbohydrate supplementation had no effect on appetite perceptions or acylated ghrelin concentrations after breakfast consumption or omission. As such, carbohydrate supplementation increased total energy intake after breakfast consumption (10222 ± 2831 kJ vs. 7695 ± 1970 kJ p < 0.01) and omission (8058 ± 2574 kJ vs. 6174 ± 2222 kJ p = 0.02). CONCLUSION: Both breakfast consumption and carbohydrate supplementation provide beneficial dietary interventions for increasing energy intake in hypoxic conditions.

Effects of Pre-race Apneas on 400-m Freestyle Swimming Performance.

Robertson, C, Lodin-Sundström, A, O'Hara, J, King, R, Wainwright, B, and Barlow, M. Effects of pre-race apneas on 400-m freestyle swimming performance. J Strength Cond Res 34(3): 828-837, 2020-This study aimed to establish whether a series of 3 apneas before a 400-m freestyle time-trial affected swimming performance when compared with and combined with a warm-up. Nine (6 males and 3 females) regional to national standard swimmers completed four 400-m freestyle time-trials in 4 randomized conditions: without warm-up or apneas (CON), warm-up only (WU), apneas only (AP), and warm-up and apneas (WUAP). Time-trial performance was significantly improved after WUAP (275.79 ± 12.88 seconds) compared with CON (278.66 ± 13.31 seconds, p = 0.035) and AP (278.64 ± 4.10 seconds, p = 0.015). However, there were no significant differences between the WU (276.01 ± 13.52 seconds, p > 0.05) and other interventions. Spleen volume compared with baseline was significantly reduced after the apneas by a maximum of ∼45% in the WUAP and by ∼20% in WU. This study showed that the combination of a warm-up with apneas could significantly improve 400-m freestyle swim performance compared with a control and apnea intervention. Further investigation into whether long-term apnea training can enhance this response is justified.

Outcomes of Ambulatory Upper Extremity Surgery Patients Discharged Home with Perineural Catheters from a Veterans Health Administration Medical Center.

OBJECTIVE: The feasibility and safety of managing ambulatory continuous peripheral nerve blocks (CPNB) in Veterans Health Administration (VHA) patients are currently unknown. We aimed to characterize the outcomes of a large VHA cohort of ambulatory upper extremity surgery patients discharged with CPNB and identify differences, if any, between catheter types. METHODS: With institutional review board approval, we reviewed data for consecutive patients from a single VHA hospital who had received ambulatory CPNB for upper extremity surgery from March 2011 to May 2017. The composite primary outcome was the occurrence of any catheter-related issue or additional all-cause health care intervention after discharge. Our secondary outcome was the ability to achieve regular daily telephone contact. RESULTS: Five hundred one patients formed the final sample. The incidence of any issue or health care intervention was 104/274 (38%) for infraclavicular, 58/185 (31%) for interscalene, and 14/42 (33%) for supraclavicular; these rates did not differ between groups. Higher ASA status was associated with greater odds of having any issue, whereas increasing age was slightly protective. Distance was associated with an increase in catheter-related issues (P < 0.01) but not additional health care interventions (P = 0.51). Only interscalene catheter patients (3%) reported breathing difficulty. Infraclavicular catheter patients had the most emergency room visits but rarely for CPNB issues. Consistent daily telephone contact was not achieved. CONCLUSIONS: For VHA ambulatory CPNB patients, the combined incidence of a catheter-related issue or additional health care intervention was approximately one in three patients and did not differ by brachial plexus catheter type. Serious adverse events were generally uncommon.

Substrate oxidation and the influence of breakfast in normobaric hypoxia and normoxia.

PURPOSE: Previous research has reported inconsistent effects of hypoxia on substrate oxidation, which may be due to differences in methodological design, such as pre-exercise nutritional status and exercise intensity. This study investigated the effect of breakfast consumption on substrate oxidation at varying exercise intensities in normobaric hypoxia compared with normoxia. METHODS: Twelve participants rested and exercised once after breakfast consumption and once after omission in normobaric hypoxia (4300 m: FiO2 ~ 11.7%) and normoxia. Exercise consisted of walking for 20 min at 40%, 50% and 60% of altitude-specific [Formula: see text]O2max at 10-15% gradient with a 10 kg backpack. Indirect calorimetry was used to calculate carbohydrate and fat oxidation. RESULTS: The relative contribution of carbohydrate oxidation to energy expenditure was significantly reduced in hypoxia compared with normoxia during exercise after breakfast omission at 40% (22.4 ± 17.5% vs. 38.5 ± 15.5%, p = 0.03) and 60% [Formula: see text]O2max (35.4 ± 12.4 vs. 50.1 ± 17.6%, p = 0.03), with a trend observed at 50% [Formula: see text]O2max (23.6 ± 17.9% vs. 38.1 ± 17.0%, p = 0.07). The relative contribution of carbohydrate oxidation to energy expenditure was not significantly different in hypoxia compared with normoxia during exercise after breakfast consumption at 40% (42.4 ± 15.7% vs. 48.5 ± 13.3%, p = 0.99), 50% (43.1 ± 11.7% vs. 47.1 ± 14.0%, p = 0.99) and 60% [Formula: see text]O2max (54.6 ± 17.8% vs. 55.1 ± 15.0%, p = 0.99). CONCLUSIONS: Relative carbohydrate oxidation was significantly reduced in hypoxia compared with normoxia during exercise after breakfast omission but not during exercise after breakfast consumption. This response remained consistent with increasing exercise intensities. These findings may explain some of the disparity in the literature.

Liver and muscle glycogen oxidation and performance with dose variation of glucose-fructose ingestion during prolonged (3 h) exercise.

PURPOSE: This study investigated the effect of small manipulations in carbohydrate (CHO) dose on exogenous and endogenous (liver and muscle) fuel selection during exercise. METHOD: Eleven trained males cycled in a double-blind randomised order on 4 occasions at 60% [Formula: see text] for 3 h, followed by a 30-min time-trial whilst ingesting either 80 g h-1 or 90 g h-1 or 100 g h-1 13C-glucose-13C-fructose [2:1] or placebo. CHO doses met, were marginally lower, or above previously reported intestinal saturation for glucose-fructose (90 g h-1). Indirect calorimetry and stable mass isotope [13C] techniques were utilised to determine fuel use. RESULT: Time-trial performance was 86.5 to 93%, 'likely, probable' improved with 90 g h-1 compared 80 and 100 g h-1. Exogenous CHO oxidation in the final hour was 9.8-10.0% higher with 100 g h-1 compared with 80 and 90 g h-1 (ES = 0.64-0.70, 95% CI 9.6, 1.4 to 17.7 and 8.2, 2.1 to 18.6). However, increasing CHO dose (100 g h-1) increased muscle glycogen use (101.6 ± 16.6 g, ES = 0.60, 16.1, 0.9 to 31.4) and its relative contribution to energy expenditure (5.6 ± 8.4%, ES = 0.72, 5.6, 1.5 to 9.8 g) compared with 90 g h-1. Absolute and relative muscle glycogen oxidation between 80 and 90 g h-1 were similar (ES = 0.23 and 0.38) though a small absolute (85.4 ± 29.3 g, 6.2, - 23.5 to 11.1) and relative (34.9 ± 9.1 g, - 3.5, - 9.6 to 2.6) reduction was seen in 90 g h-1 compared with 100 g h-1. Liver glycogen oxidation was not significantly different between conditions (ES < 0.42). Total fat oxidation during the 3-h ride was similar in CHO conditions (ES < 0.28) but suppressed compared with placebo (ES = 1.05-1.51). CONCLUSION: 'Overdosing' intestinal transport for glucose-fructose appears to increase muscle glycogen reliance and negatively impact subsequent TT performance.

The availability of water associated with glycogen during dehydration: a reservoir or raindrop?

PURPOSE: This study evaluated whether glycogen-associated water is a protected entity not subject to normal osmotic homeostasis. An investigation into practical and theoretical aspects of the functionality of this water as a determinant of osmolality, dehydration, and glycogen concentration was undertaken. METHODS: In vitro experiments were conducted to determine the intrinsic osmolality of glycogen-potassium phosphate mixtures as would be found intra-cellularly at glycogen concentrations of 2% for muscle and 5 and 10% for liver. Protected water would not be available to ionic and osmotic considerations, whereas free water would obey normal osmotic constraints. In addition, the impact of 2 L of sweat loss in situations of muscle glycogen repletion and depletion was computed to establish whether water associated with glycogen is of practical benefit (e.g., to increase "available total body water"). RESULTS: The osmolality of glycogen-potassium phosphate mixtures is predictable at 2% glycogen concentration (predicted 267, measured 265.0 ± 4.7 mOsmol kg-1) indicating that glycogen-associated water is completely available to all ions and is likely part of the greater osmotic system of the body. At higher glycogen concentrations (5 and 10%), there was a small amount of glycogen water (~ 10-20%) that could be considered protected. However, the majority of the glycogen-associated water behaved to normal osmotic considerations. The theoretical exercise of selective dehydration (2 L) indicated a marginal advantage to components of total body water such as plasma volume (1.57% or 55 mL) when starting exercise glycogen replete. CONCLUSION: Glycogen-associated water does not appear to be a separate reservoir and is not able to uniquely replete water loss during dehydration.

Novel essential amino acid supplements enriched with L-leucine facilitate increased protein and energy intakes in older women: a randomised controlled trial.

BACKGROUND: Inadequate protein intake (PI), containing a sub-optimal source of essential amino acids (EAAs), and reduced appetite are contributing factors to age-related sarcopenia. The satiating effects of dietary protein per se may negatively affect energy intake (EI), thus there is a need to explore alternative strategies to facilitate PI without compromising appetite and subsequent EI. METHODS: Older women completed two experiments (EXP1 and EXP2) where they consumed either a Bar (565 kJ), a Gel (477 kJ), both rich in EAAs (7.5 g, 40% L-leucine), or nothing (Control). In EXP1, participants (n = 10, 68 ± 5 years, mean ± SD) consumed Bar, Gel or Control with appetite sensations and appetite-related hormonal responses monitored for one hour, followed by consumption of an ad libitum breakfast (ALB). In EXP2, participants (n = 11, 69 ± 5 years) ingested Bar, Gel or Control alongside an ALB. RESULTS: In EXP1, EI at ALB was not different (P = 0.674) between conditions (1179 ± 566, 1254 ± 511, 1206 ± 550 kJ for the Control, Bar, and Gel respectively). However, total EI was significantly higher in the Bar and Gel compared to the Control after accounting for the energy content of the supplements (P < 0.0005). Analysis revealed significantly higher appetite Area under the Curve (AUC) (P < 0.007), a tendency for higher acylated ghrelin AUC (P = 0.087), and significantly lower pancreatic polypeptide AUC (P = 0.02) in the Control compared with the Bar and Gel. In EXP2, EI at ALB was significantly higher (P = 0.028) in the Control (1282 ± 513 kJ) compared to the Bar (1026 ± 565 kJ) and Gel (1064 ± 495 kJ). However, total EI was significantly higher in the Bar and Gel after accounting for the energy content of the supplements (P < 0.007). CONCLUSIONS: Supplementation with either the Bar or Gel increased total energy intake whether consumed one hour before or during breakfast. This may represent an effective nutritional means for addressing protein and total energy deficiencies in older women. TRIAL REGISTRATION: Clinical trial register: retrospectively registered, ISRCTN12977929 on.

Dietary Intakes of Elite 14- to 19-Year-Old English Academy Rugby Players During a Pre-Season Training Period.

Good nutrition is essential for the physical development of adolescent athletes, however data on dietary intakes of adolescent rugby players are lacking. This study quantified and evaluated dietary intake in 87 elite male English academy rugby league (RL) and rugby union (RU) players by age (under 16 (U16) and under 19 (U19) years old) and code (RL and RU). Relationships of intakes with body mass and composition (sum of 8 skinfolds) were also investigated. Using 4-day diet and physical activity diaries, dietary intake was compared with adolescent sports nutrition recommendations and the UK national food guide. Dietary intake did not differ by code, whereas U19s consumed greater energy (3366 ± 658 vs. 2995 ± 774 kcal·day-1), protein (207 ± 49 vs. 150 ± 53 g·day-1) and fluid (4221 ± 1323 vs. 3137 ± 1015 ml·day-1) than U16s. U19s consumed a better quality diet than U16s (greater intakes of fruit and vegetables; 4.4 ± 1.9 vs. 2.8 ± 1.5 servings·day-1; nondairy proteins; 3.9 ± 1.1 vs. 2.9 ± 1.1 servings·day-1) and less fats and sugars (2.0 ± 1. vs. 3.6 ± 2.1 servings·day-1). Protein intake vs. body mass was moderate (r = .46, p < .001), and other relationships were weak. The findings of this study suggest adolescent rugby players consume adequate dietary intakes in relation to current guidelines for energy, macronutrient and fluid intake. Players should improve the quality of their diet by replacing intakes from the fats and sugars food group with healthier choices, while maintaining current energy, and macronutrient intakes.

Are Habitual Hydration Strategies of Female Rugby League Players Sufficient to Maintain Fluid Balance and Blood Sodium Concentration During Training and Match-Play? A Research Note From the Field.

Limited data exist on the hydration status of female athletes, with no data available on female rugby players. The objective of this study was to investigate the habitual hydration status on arrival, sweat loss, fluid intake, sweat Na loss, and blood [Na+] during field training and match-play in 10 international female rugby league players. Urine osmolality on arrival to match-play (382 ± 302 mOsmol·kg(-1)) and training (667 ± 260 mOsmol·kg(-1)) was indicative of euhydration. Players experienced a body mass loss of 0.50 ± 0.45 and 0.56 ± 0.53% during match-play and training, respectively. During match-play, players consumed 1.21 ± 0.43 kg of fluid and had a sweat loss of 1.54 ± 0.48 kg. During training, players consumed 1.07 ± 0.90 kg of fluid, in comparison with 1.25 ± 0.83 kg of sweat loss. Blood [Na+] was well regulated (Δ-0.7 ± 3.4 and Δ-0.4 ± 2.6 mmol·L(-1)), despite sweat [Na+] of 47.8 ± 5.7 and 47.2 ± 6.3 mmol·L(-1) during match-play and training. The findings of this study show mean blood [Na+] that seems to be well regulated despite losses of Na in sweat and electrolyte-free fluid consumption. For the duration of the study, players did not experience a body mass loss (dehydration >2%) indicative of a reduction in exercise performance, thus habitual hydration strategies seem adequate. Practitioners should evaluate the habitual hydration status of athletes to determine whether interventions above habitual strategies are warranted.

Dehydration and hyponatremia in professional rugby union players: a cohort study observing english premiership rugby union players during match play, field, and gym training in cool environmental conditions.

Fluid and sodium balance is important for performance and health; however, limited data in rugby union players exist. The purpose of the study was to evaluate body mass (BM) change (dehydration) and blood[Na] change during exercise. Data were collected from 10 premiership rugby union players, over a 4-week period. Observations included match play (23 subject observations), field (45 subject observations), and gym (33 subject observations) training sessions. Arrival urine samples were analyzed for osmolality, and samples during exercise were analyzed for [Na]. Body mass and blood[Na] were determined pre- and postexercise. Sweat[Na] was analyzed from sweat patches worn during exercise, and fluid intake was measured during exercise. Calculations of fluid and Na loss were made. Mean arrival urine osmolality was 423 ± 157 mOsm·kg, suggesting players were adequately hydrated. After match play, field, and gym training, BM loss was 1.0 ± 0.7, 0.3 ± 0.6, and 0.1 ± 0.6%, respectively. Fluid loss was significantly greater during match play (1.404 ± 0.977 kg) than field (1.008 ± 0.447 kg, p = 0.021) and gym training (0.639 ± 0.536 kg, p < 0.001). Fluid intake was 0.955 ± 0.562, 1.224 ± 0.601, and 0.987 ± 0.503 kg during match play, field, and gym training, respectively. On 43% of observations, players were hyponatremic when BM increased, 57% when BM was maintained, and 35% when there was a BM loss of 0.1-0.9%. Blood[Na] was the representative of normonatremia when BM loss was >1.0%. The findings demonstrate that rugby union players are adequately hydrated on arrival, fluid intake is excessive compared with fluid loss, and some players are at risk of developing hyponatremia.

The effect of pre-exercise galactose and glucose ingestion on high-intensity endurance cycling.

This study evaluated the effects of the pre-exercise (30 minutes) ingestion of galactose (Gal) or glucose (Glu) on endurance capacity as well as glycemic and insulinemic responses. Ten trained male cyclists completed 3 randomized high-intensity cycling endurance tests. Thirty minutes before each trial, cyclists ingested 1 L of either 40 g of glucose, 40 g of galactose, or a placebo in a double-blind manner. The protocol comprised 20 minutes of progressive incremental exercise (70-85% maximal power output [Wmax]); ten 90-second bouts at 90% Wmax, separated by 180 seconds at 55% Wmax; and 90% Wmax until exhaustion. Blood samples were drawn throughout the protocol. Times to exhaustion were longer with Gal (68.7 ± 10.2 minutes, p = 0.005) compared with Glu (58.5 ± 24.9 minutes), with neither being different to placebo (63.9 ± 16.2 minutes). Twenty-eight minutes after Glu consumption, plasma glucose and serum insulin concentrations were higher than with Gal and placebo (p < 0.001). After the initial 20 minutes of exercise, plasma glucose concentrations increased to a relative hyperglycemia during the Gal and placebo, compared with Glu condition. Higher plasma glucose concentrations during exercise, and the attenuated serum insulin response at rest, may explain the significantly longer times to exhaustion produced by Gal compared with Glu. However, neither carbohydrate treatment produced significantly longer times to exhaustion than placebo, suggesting that the pre-exercise ingestion of galactose and glucose alone is not sufficient to support this type of endurance performance.

Liver and muscle glycogen repletion using 13C magnetic resonance spectroscopy following ingestion of maltodextrin, galactose, protein and amino acids.

The present study evaluated whether the inclusion of protein (PRO) and amino acids (AA) within a maltodextrin (MD) and galactose (GAL) recovery drink enhanced post-exercise liver and muscle glycogen repletion. A total of seven trained male cyclists completed two trials, separated by 7 d. Each trial involved 2 h of standardised intermittent cycling, followed by 4 h recovery. During recovery, one of two isoenergetic formulations, MD-GAL (0.9 g MD/kg body mass (BM) per h and 0.3 g GAL/kg BM per h) or MD-GAL-PRO+AA (0.5 g MD/kg BM per h, 0.3 g GAL/kg BM per h, 0.4 g whey PRO hydrolysate plus l-leucine and l-phenylalanine/kg BM per h) was ingested at every 30 min. Liver and muscle glycogen were measured after depletion exercise and at the end of recovery using 1H-13C-magnetic resonance spectroscopy. Despite higher postprandial insulin concentations for MD-GAL-PRO+AA compared with MD-GAL (61.3 (se 6.2) v. 29.6 (se 3.0) mU/l, (425.8 (se 43.1) v. 205.6 (se 20.8) pmol/l) P= 0.03), there were no significant differences in post-recovery liver (195.3 (se 2.6) v. 213.8 (se 18.0) mmol/l) or muscle glycogen concentrations (49.7 (se 4.0) v. 51.1 (se 7.9) mmol/l). The rate of muscle glycogen repletion was significantly higher for MD-GAL compared with MD-GAL-PRO+AA (5.8 (se 0.7) v. 3.7 (se 0.6) mmol/l per h, P= 0.04), while there were no significant differences in the rate of liver glycogen repletion (15.0 (se 2.5) v. 13.0 (se 2.7) mmol/l per h). PRO and AA within a MD-GAL recovery drink, compared with an isoenergetic mix of MD-GAL, did not enhance but matched liver and muscle glycogen recovery. This suggests that the increased postprandial insulinaemia only compensated for the lower MD content in the MD-GAL-PRO+AA treatment.

Early career outcomes of a large four-year MD/ MPH program: Results of a cross sectional survey of three cohorts of graduates.

The University of Miami Miller School of Medicine started a four-year MD/ MPH program in 2011 with a mission to graduate public health physician leaders to address the public health needs of the 21st century, with emphasis on three areas: leadership, research, and public health. A prospective cross-sectional survey of early graduates was conducted to understand how they incorporate public health training into their careers. There were two study questions: What are the self-described early career activities of the graduates of the first three cohorts in the areas of leadership, research, and public health and what are the perceptions regarding the influence of the public health training on their careers? In the summer of 2020, a survey was sent to graduates from the classes of 2015, 2016, and 2017. In addition to several multiple-choice questions, the survey included an open-ended question on the impact of public health training in their careers. Inductive content analysis was used to analyze the responses to the open-ended question. Eighty-two of the 141 eligible graduates (63%) completed the survey; 80 of whom had participated or was currently participating in residency training. Forty-nine joined a residency in a primary care field. Many graduates had leadership roles in their early careers, including 35 who were selected as chief residents. Fifty-seven participated in research, most commonly in quality improvement (40), clinical (34) and community based (19). Over one third (30) chose to do work in public health during residency. Themes that emerged regarding the influence of public health training on their careers were: 1) Shifts in perspective, 2) Value of specific skills related to public health, 3) Steppingstone for professional opportunities 4) Focus on health disparities, social determinants, and inadequacies of the healthcare system, 5) Perception as leaders and mentors for peers, and 6) Preparedness for the pandemic. Graduates self-reported involvement in leadership, research, and public health activities as well as a commitment towards addressing some of our most pressing public health needs. Although long-term career outcomes need to be determined over time, graduates currently report considerable benefits of their public health training for their professional outcomes.

Case study of a female ocean racer: prerace preparation and nutritional intake during the Vendée Globe 2008.

The Vendée Globe is a solo round-the-world sailing race without stopovers or assistance, a physically demanding challenge for which appropriate nutrition should maintain energy balance and ensure optimum performance. This is an account of prerace nutritional preparation with a professional and experienced female racer and assessment of daily nutritional intake (NI) during the race using a multimethod approach. A daily energy intake (EI) of 15.1 MJ/day was recommended for the race and negotiated down by the racer to 12.7 MJ/day, with carbohydrate and fluid intake goals of 480 g/day and 3,020 ml/day, respectively. Throughout the 99-day voyage, daily NI was recorded using electronic food diaries and inventories piloted during training races. NI was assessed and a postrace interview and questionnaire were used to evaluate the intervention. Fat mass (FM) and fat-free mass (FFM) were assessed pre- (37 days) and postrace (11 days) using dual-energy X-ray absorptiometry, and body mass was measured before the racer stepped on the yacht and immediately postrace. Mean EI was 9.2 MJ/day (2.4-14.3 MJ/day), representing a negative energy balance of 3.5 MJ/day under the negotiated EI goal, evidenced by a 7.9-kg loss of body mass (FM -7.5 kg, FFM -0.4 kg) during the voyage, with consequent underconsumption of carbohydrate by ~130 g/day. According to the postrace yacht food inventory, self-reported EI was underreported by 7%. This intervention demonstrates the practicality of the NI approach and assessment, but the racer's nutrition strategy can be further improved to facilitate meeting more optimal NI goals for performance and health. It also shows that evaluation of NI is possible in this environment over prolonged periods, which can provide important information for optimizing nutritional strategies for ocean racing.

Sex Disparity Persists in Pain Medicine: A Cross-Sectional Study of Chairpersons Within ACGME-Accredited Chronic Pain Fellowship Programs in the United States.

Objective: To compare the representation of female and male chairpersons and evaluate their respective demographic, academic, and program-related characteristics in academic chronic pain institutions. Methods: We identified all chronic pain fellowship programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME) on April 19, 2021. We queried institutional websites or contacted programs directly to identify the respective departmental/divisional program chairperson. We abstracted data on program chairpersons from public databases and performed statistical comparisons of demographic, academic, and program-related characteristics between female and male program chairpersons. Results: Of the 111 ACGME-accredited chronic pain fellowship programs, we identified the current chairperson at 87 programs (78.4%). There were 17 female chairpersons (19.5%) and 70 male chairpersons (80.5%). A higher proportion of female chairpersons reported an academic rank of assistant professor compared with male chairpersons (35.3% vs 11.4%, P = .027). Male chairpersons published more peer-reviewed articles compared with female chairpersons (median 32.0 vs 10.0 publications, P = .001). Concordantly, male chairpersons achieved a higher H-index score compared with female chairpersons (median 10.0 vs 3.0, P = .001). No differences were identified in other academic or program-related characteristics. Conclusion: This cross-sectional study illuminates important details on sex-related differences in the chronic pain program chair role. Women chairpersons are underrepresented, have fewer peer-reviewed publications, and achieved a lower H-index score compared with male chairpersons. Establishing these baseline associations provides a reference for future studies to evaluate changes over time.

A mixed methods study reviewing consumer experiences for oral health treatment in Medicaid-eligible children in Florida.

OBJECTIVES: Oral health is essential to a person's overall health, well-being, and dignity; unfortunately, dental caries, which can cause pain and difficulty eating, affect approximately 50 percent of children between 6 and 8 years old. This is in part because Medicaid-eligible children face numerous obstacles obtaining dental care. To date, there are 74 million Americans who do not have dental coverage or access to dental services, which is strongly associated with race, class, gender, and ethnicity. The objective of this research was to identify barriers to accessing and utilizing children's Medicaid oral health care and services, to evaluate care delivery and quality, and to assist in establishing a more consumer-driven approach. METHODS: A mixed methods study was conducted throughout the state of Florida, using qualitative and quantitative data collection to seek answers to these questions. There were 422 surveys and 39 interviews distributed to Medicaid-eligible families and individuals across the state; data collection focused on experiences with oral health care, gaps in current access to Medicaid dental care, and concerns when utilizing care. RESULTS: Our study shows the majority of barriers parents face when accessing Medicaid oral health care are due to logistical access issues, such as cost, appointment wait-times, and confusion surrounding which dental providers accept specific insurance plans. The findings also highlight how location, race, language, and ethnicity impact families who lack preventive dental health services access and how, in turn, families view their own access to dental services. CONCLUSION: Ultimately, there exists an avenue to implement programs and policies that address existing disparities in oral health to improve health outcomes by increasing access to care and reducing cultural and socioeconomic barriers.

Glucose and Fructose Hydrogel Enhances Running Performance, Exogenous Carbohydrate Oxidation, and Gastrointestinal Tolerance.

PURPOSE: Beneficial effects of carbohydrate (CHO) ingestion on exogenous CHO oxidation and endurance performance require a well-functioning gastrointestinal (GI) tract. However, GI complaints are common during endurance running. This study investigated the effect of a CHO solution-containing sodium alginate and pectin (hydrogel) on endurance running performance, exogenous and endogenous CHO oxidation, and GI symptoms. METHODS: Eleven trained male runners, using a randomized, double-blind design, completed three 120-min steady-state runs at 68% V˙O2max, followed by a 5-km time-trial. Participants ingested 90 g·h-1 of 2:1 glucose-fructose (13C enriched) as a CHO hydrogel, a standard CHO solution (nonhydrogel), or a CHO-free placebo during the 120 min. Fat oxidation, total and exogenous CHO oxidation, plasma glucose oxidation, and endogenous glucose oxidation from liver and muscle glycogen were calculated using indirect calorimetry and isotope ratio mass spectrometry. GI symptoms were recorded throughout the trial. RESULTS: Time-trial performance was 7.6% and 5.6% faster after hydrogel ([min:s] 19:29 ± 2:24, P < 0.001) and nonhydrogel (19:54 ± 2:23, P = 0.002), respectively, versus placebo (21:05 ± 2:34). Time-trial performance after hydrogel was 2.1% faster (P = 0.033) than nonhydrogel. Absolute and relative exogenous CHO oxidation was greater with hydrogel (68.6 ± 10.8 g, 31.9% ± 2.7%; P = 0.01) versus nonhydrogel (63.4 ± 8.1 g, 29.3% ± 2.0%; P = 0.003). Absolute and relative endogenous CHO oxidation was lower in both CHO conditions compared with placebo (P < 0.001), with no difference between CHO conditions. Absolute and relative liver glucose oxidation and muscle glycogen oxidation were not different between CHO conditions. Total GI symptoms were not different between hydrogel and placebo, but GI symptoms were higher in nonhydrogel compared with placebo and hydrogel (P < 0.001). CONCLUSION: The ingestion of glucose and fructose in hydrogel form during running benefited endurance performance, exogenous CHO oxidation, and GI symptoms compared with a standard CHO solution.

Quantitation of plasma 13C-galactose and 13C-glucose during exercise by liquid chromatography/isotope ratio mass spectrometry.

The utilisation of carbohydrate sources under exercise conditions is of considerable importance in performance sports. Incorporation of optimal profiles of macronutrients can improve endurance performance in athletes. However, gaining an understanding of the metabolic partitioning under sustained exercise can be problematical and isotope labelling approaches can help quantify substrate utilisation. The utilisation of oral galactose was investigated using (13)C-galactose and measurement of plasma galactose and glucose enrichment by liquid chromatography/isotope ratio mass spectrometry (LC/IRMS). As little as 100 µL plasma could readily be analysed with only minimal sample processing. Fucose was used as a chemical and isotopic internal standard for the quantitation of plasma galactose and glucose concentrations, and isotopic enrichment. The close elution of galactose and glucose required a correction routine to be implemented to allow the measurement, and correction, of plasma glucose δ(13)C, even in the presence of very highly enriched galactose. A Bland-Altman plot of glucose concentration measured by LC/IRMS against glucose measured by an enzymatic method showed good agreement between the methods. Data from seven trained cyclists, undergoing galactose supplementation before exercise, demonstrate that galactose is converted into glucose and is available for subsequent energy metabolism.

Bridging the digital divide in health care: the role of health information technology in addressing racial and ethnic disparities.

BACKGROUND: Racial and ethnic disparities in health care have been consistently documented in the diagnosis, treatment, and outcomes of many common clinical conditions. There has been an acceleration of health information technology (HIT) implementation in the United States, with health care reform legislation including multiple provisions for collecting and using health information to improve and monitor quality and efficiency in health care. Despite an uneven and generally low level of implementation, research has demonstrated that HIT has the potential to improve quality of care and patient safety. If carefully designed and implemented, HIT also has the potential to eliminate disparities. HIT AND DISPARITIES: Several root causes for disparities are amenable to interventions using HIT, particularly innovations in electronic health records, as well as strategies for chronic disease management. Recommendations regardinghealth care system, provider, and patient factors can help health care organizations address disparities as they adopt, expand, and tailor their HIT systems. In terms of health care system factors, organizations should (1) automate and standardize the collection of race/ethnicity and language data, (2) prioritize the use of the data for identifying disparities and tailoring improvement efforts, (3) focus HIT efforts to address fragmented care delivery for racial/ethnic minorities and limited-English-proficiency patients, (4) develop focused computerized clinical decision support systems for clinical areas with significant disparities, and (5) include input from racial/ethnic minorities and those with limited English proficiency in developing patient HIT tools to address the digital divide. CONCLUSIONS: As investments are made in HIT, consideration must be given to the impact that these innovations have on the quality and cost of health care for all patients, including those who experience disparities.