Examining the COVID-19 impact on cancer surgery in Ireland using three national data sources.

Background: The healthcare system in Ireland was profoundly affected by COVID-19. This study aimed to explore the impact of the pandemic on cancer surgery in Ireland, from 2019 to 2022 using three national health data sources. Methods: A repeated cross-sectional study design was used and included: (i) cancer resections from the National Histopathology Quality Improvement (NHQI) Programmes; (ii) cancer surgery from the National Cancer Registry Ireland (NCRI), and (iii) cancer surgery from Hospital Inpatient Enquiry (HIPE) System. Cancer surgery was presented by invasive/in situ and invasive only cancers (NCRI & HIPE), and by four main cancer types (breast, lung, colorectal & melanoma for NCRI & HIPE data only). Results: The annual number of cancer resections (NHQI) declined by 4.4% in 2020 but increased by 4% in 2021 compared with 2019. NCRI data indicated invasive/in-situ cancer surgery for the four main cancer types declined by 14% in 2020 and 5.1% in 2021, and by 12.3% and 7.3% for invasive cancer only, compared to 2019. Within HIPE for the same tumour types, invasive/in situ cancer surgery declined by 21.9% in 2020 and 9.9% in 2021 and by 20.8% and 9.6% for invasive cancer only. NHQI and HIPE data indicated an increase in the number of cancer surgeries performed in 2022. Conclusions: Cancer surgery declined in the initial pandemic waves suggests mitigation measures for cancer surgery, including utilising private hospitals for public patients, reduced the adverse impact on cancer surgery.

Engaging athletes as research participants. A document analysis of published sport science literature.

Sport science practitioners utilise findings from peer reviewed research to inform practice. Fewer studies are conducted with high performance athletes, however, than those involving recreationally active participants. Noting that research findings from recreational athletes may not be generalisable to the elite, there is a need to engage the latter cohort in research with better potential to influence health and performance. This study identified methods used to engage and recruit highly trained, elite and world class athletes as research participants. A document analysis was conducted using a purposive sample of peer-reviewed sport science literature. All articles published in 2022 from 18 highly ranked sport science journals were screened for inclusion. Studies investigating athletes ranked as highly trained/national level or above were included. All details related to participant recruitment were extracted from included articles, with the content being coded and thematically analysed using an interpretivist approach. A total of 439 studies from the 2356 screened were included in the analysis. Five primary themes of recruitment strategies were identified, beneath an overarching strategy of purposeful, convenience sampling. Recruitment themes related to the use of a gatekeeper, the research environment providing convenient access to athletes, promoting the study electronically, utilising professional networks and recruiting at training or competition. Engaging athletes through a gatekeeper is a prominent strategy to involve elite athletes in research. It is suggested that researchers work collaboratively with team or organisation personnel to promote recruitment, creating co-designed approaches that address issues most relevant to athletes and staff.

Impact of acute dietary and exercise manipulation on next day RMR measurements and DXA body composition estimates.

PURPOSE: To investigate the effects of acute diet and exercise manipulation on resting metabolic rate (RMR) measurement variability and dual energy x-ray absorptiometry (DXA) body composition estimates. METHODS: 10 male and 10 female endurance athletes (12 cyclists, 5 triathletes, 4 runners) of Tier 2 (n = 18) to Tier 3 (n = 2) calibre underwent five conditions using a Latin square counterbalance design. For 24 hours, athletes consumed a diet providing excessive energy availability (75 kcal‧kg fat free mass (FFM) -1 ) without exercise (GEA rest ), high energy availability (45 kcal‧kg FFM -1 ) without (HEA rest ) or with exercise (HEA ex ), or low-energy availability (15 kcal‧kg FFM -1 ) without (LEA rest ) or with exercise (LEA ex ). Exercise involved two bouts of cycling (morning bout: 149 ± 34 min at 55% of maximal aerobic capacity (VO 2 max); afternoon bout: 60 min at 65% of VO 2 max) that resulted in a cumulative exercise energy expenditure of 30 kcal‧kg FFM -1 . The following day, RMR and DXA measurements occurred after a 10-hour fast and 12-hours post-exercise. RESULTS: There were no sex differences in relative RMR ( p = 0.158) nor effects of any of the five conditions on RMR ( p = 0.358). For both male and female athletes, FFM estimates were decreased following the LEA rest (-0.84 ± 0.66 kg; p = 0.001) and LEA ex (-0.65 ± 0.86 kg; p = 0.016) conditions compared to the GEA rest condition and following the LEA rest (-0.73 ± 0.51 kg; p = 0.001) and LEA ex (-0.54 ± 0.79 kg; p = 0.024) conditions compared to the HEA ex condition. There was no effect of condition on fat mass estimates ( p = 0.819). CONCLUSION: Acute periods of diet and exercise manipulation did not create artifacts in next-day RMR measurements. However, as changes in estimates of FFM were seen, diet and exercise should be controlled in the 24-hours prior to DXA scans.

Delaying post-exercise carbohydrate intake impairs next-day exercise capacity but not muscle glycogen or molecular responses.

AIM: To investigate how delayed post-exercise carbohydrate intake affects muscle glycogen, metabolic- and mitochondrial-related molecular responses, and subsequent high-intensity interval exercise (HIIE) capacity. METHODS: In a double-blind cross-over design, nine recreationally active men performed HIIE (10 × 2-min cycling, ~94% W˙peak) in the fed state, on two occasions. During 0-3 h post-HIIE, participants drank either carbohydrates ("Immediate Carbohydrate" [IC], providing 2.4 g/kg) or water ("Delayed Carbohydrate" [DC]); total carbohydrate intake over 24 h post-HIIE was matched (~7 g/kg/d). Skeletal muscle (sampled pre-HIIE, post-HIIE, +3 h, +8 h, +24 h) was analyzed for whole-muscle glycogen and mRNA content, plus signaling proteins in cytoplasmic- and nuclear-enriched fractions. After 24 h, participants repeated the HIIE protocol until failure, to test subsequent HIIE capacity; blood lactate, heart rate, and ratings of perceived effort (RPE) were measured throughout. RESULTS: Muscle glycogen concentrations, and relative changes, were similar between conditions throughout (p > 0.05). Muscle glycogen was reduced from baseline (mean ± SD mmol/kg dm; IC: 409 ± 166; DC: 352 ± 76) at post-HIIE (IC: 253 ± 96; DC: 214 ± 82), +3 h (IC: 276 ± 62; DC: 269 ± 116) and + 8 h (IC: 321 ± 56; DC: 269 ± 116), returning to near-baseline by +24 h. Several genes (PGC-1ɑ, p53) and proteins (p-ACCSer79, p-P38 MAPKThr180/Tyr182) elicited typical exercise-induced changes irrespective of condition. Delaying carbohydrate intake reduced next-day HIIE capacity (5 ± 3 intervals) and increased RPE (~2 ratings), despite similar physiological responses between conditions. CONCLUSION: Molecular responses to HIIE (performed in the fed state) were not enhanced by delayed post-exercise carbohydrate intake. Our findings support immediate post-exercise refueling if the goal is to maximize next-day HIIE capacity and recovery time is ≤24 h.

Impact of the COVID-19 pandemic on electronic referrals to rapid access clinics for suspected breast, lung and prostate cancers in Ireland.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic impacted cancer services worldwide. We examined the effect of the first three pandemic waves on the number of electronic (e)-referrals to rapid access clinics (RACs) for breast, lung and prostate cancer in Ireland. METHODS: This study used a retrospective, repeated cross-sectional design. The predicted weekly number of e-referrals by suspected cancer types from March 2020 to May 2021 was calculated using the Holt-Winters seasonal smoothing method, based on the observed numbers from a representative pre-pandemic period (01 January 2019 to 01 March 2020) and compared this with the observed number across the first three pandemic waves (02 March 2020 to 09 May 2021). Percentage differences were calculated between observed and predicted numbers of e-referrals for the three RACs and patterns were examined in each wave. RESULTS: Observed e-referrals were lower than predicted for all three RACs in the first wave of the pandemic (15.7% lower for breast, 39.5% lower for lung and 28.1% lower for prostate) with varying levels of recovery in the second and third waves for the three e-referral types. CONCLUSIONS: The COVID-19 pandemic impacted patterns of e-referrals to RACs in the first three pandemic waves in Ireland. Early identification of changes in engagement with health services, such as a decrease in primary care presentations with a resultant decrease in e-referrals to RACs can allow for a rapid response from cancer control programmes. Continued surveillance of the impact of service disruption on cancer services allows policy makers and strategic leaders in cancer control programmes to respond rapidly to mitigate the impact on cancer outcomes.

The Influence of Nutrition Intervention on the P1NP and CTX-1 Response to an Acute Exercise Bout: A Systematic Review with Meta-Analysis.

BACKGROUND: Although nutrition and exercise both influence bone metabolism, little is currently known about their interaction, or whether nutritional intervention can modulate the bone biomarker response to acute exercise. Improved understanding of the relationships between nutrition, exercise and bone metabolism may have substantial potential to inform nutritional interventions to protect the bone health of exercising individuals, and to elucidate mechanisms by which exercise and nutrition influence bone. OBJECTIVE: The aim was to synthesise available evidence related to the influence of nutrition on the response of the bone biomarkers procollagen type 1 N-terminal propeptide (P1NP) and C-terminal telopeptide of type 1 collagen (CTX-1) to acute exercise, using a systematic review and meta-analytic approach. METHODS: Studies evaluating the influence of nutritional status or intervention on the bone biomarker response to an acute exercise bout were included and separated into four categories: (1) feeding status and energy availability, (2) macronutrients, (3) micronutrients and (4) other. Studies conducted on healthy human populations of any age or training status were included. Meta-analysis was conducted when data from at least five studies with independent datasets were available. In the case of insufficient data to warrant meta-analysis, results from individual studies were narratively synthesised and standardised mean effect sizes visually represented. RESULTS: Twenty-two articles were included. Of these, three investigated feeding status or energy availability, eight macronutrients, eight micronutrients (all calcium) and six other interventions including dairy products or collagen supplementation. Three studies had more than one intervention and were included in all relevant outcomes. The largest and most commonly reported effects were for the bone resorption marker CTX-1. Meta-analysis indicated that calcium intake, whether provided via supplements, diet or infusion, reduced exercise-induced increases in CTX-1 (effect size - 1.1; 95% credible interval [CrI] - 2.2 to - 0.05), with substantially larger effects observed in studies that delivered calcium via direct infusion versus in supplements or foods. Narrative synthesis suggests that carbohydrate supplementation may support bone during acute exercise, via reducing exercise-induced increases in CTX-1. Conversely, a low-carbohydrate/high-fat diet appears to induce the opposite effect, as evidenced by an increased exercise associated CTX-1 response, and reduced P1NP response. Low energy availability may amplify the CTX-1 response to exercise, but it is unclear whether this is directly attributable to energy availability or to the lack of specific nutrients, such as carbohydrate. CONCLUSION: Nutritional intervention can modulate the acute bone biomarker response to exercise, which primarily manifests as an increase in bone resorption. Ensuring adequate attention to nutritional factors may be important to protect bone health of exercising individuals, with energy, carbohydrate and calcium availability particularly important to consider. Although a wide breadth of data were available for this evidence synthesis, there was substantial heterogeneity in relation to design and intervention characteristics. Direct and indirect replication is required to confirm key findings and to generate better estimates of true effect sizes.

The Temporal Effects of Altitude and Low Energy Availability Manipulation on Resting Metabolic Rate in Female Race Walkers.

PURPOSE: To investigate the temporal effects of ~1,800 m altitude exposure and energy availability (EA) manipulation on resting metabolic rate (RMR). METHODS: Twenty elite female race walkers underwent a 3-week training camp at an altitude of ~1,800 m. During the first two weeks, athletes consumed a high EA (HEA) diet of 45 kcal·kg fat free mass (FFM) -1 ·day -1 . During the final week, half the athletes consumed a low EA (LEA) diet of 15 kcal·kg FFM -1 ·day -1 while the others continued on a HEA diet. Athletes followed individualized training plans throughout the study. To assess the effect of altitude on RMR, athletes in the HEA group had RMR measured at baseline (~580 m) prior to altitude exposure (Pre-alt), at 36-hours (36 h-alt), 2 weeks (Wk2-alt) and 3 weeks into altitude exposure (Wk3-alt), and at 36 hours post-altitude exposure at ~580 m (36 h-post). To assess the effect of LEA exposure on RMR while at altitude, athletes in the LEA group underwent RMR measurements at Pre-alt and before (Wk2-alt) and after the 7-days of LEA (Wk3-alt). RESULTS: Compared to Pre-alt, the RMR of HEA athletes was increased at 36 h-alt (+5.3 ± 3.1%; p = 0.026) and Wk2-alt (+4.9 ± 4.9%; p = 0.049), but was no longer elevated at Wk3-alt (+1.7 ± 4.2%; p = 0.850). The RMR of HEA athletes at 36 h-post was lower than all timepoints at altitude (p < 0.05) but was not different from Pre-alt (-3.9 ± 7.2%; p = 0.124). The 7-day period of LEA exposure at altitude did not affect RMR (p = 0.347). CONCLUSIONS: RMR was transiently increased with ~1,800 m altitude exposure in female athletes and was unaffected by short-term LEA. However, the altitude-induced increase was small (~25-75 kcal/day) and was unlikely to have clinically significant implications for daily energy requirements.

High-level performances following low altitude training and tapering in warm environments in elite racewalkers.

Current guidelines for prolonged altitude exposure suggest altitude levels ranging from 2000 to 2500 m to optimize an increase in total hemoglobin mass (Hbmass). However, natural low altitude locations (<2000 m) remain popular, highlighting the interest to investigate any possible benefit of low altitude camps for endurance athletes. Ten elite racewalkers (4 women and 6 men) underwent a 4-week "live high-train high" (LHTH) camp at an altitude of 1720 m (PIO2 = 121 mmHg; 20.1°C; 67% relative humidity [RH]), followed by a 3-week tapering phase (20 m; PIO2 = 150 mmHg; 28.3°C; 53% RH) in preparation for the World Athletics Championships (WC). Venous blood samples were withdrawn weekly during the entire observation period. In addition, blood volumes were determined weekly by carbon monoxide rebreathing during altitude exposure and 2 weeks after return to sea level. High-level performances were achieved at the WC (five placings among the Top 10 WC races and three all-time career personal bests). A slight but significant increase in absolute (+1.7%, p = 0.03) and relative Hbmass (+2.3%, p = 0.02) was observed after 4-week LHTH. In addition, as usually observed during LHTH protocols, weekly training distance (+28%, p = 0.02) and duration (+30%, p = 0.04) significantly increased during altitude compared to the pre-LHTH period. Therefore, although direct causation cannot be inferred, these results suggest that the combination of increased training load at low altitudes with a subsequent tapering period in a warm environment is a suitable competition-preparation strategy for elite endurance athletes.

The role of pathologists in the diagnosis of occupational lung diseases: an expert opinion of the European Society of Pathology Pulmonary Pathology Working Group.

Occupational lung/thoracic diseases are a major global public health issue. They comprise a diverse spectrum of health conditions with complex pathology, most of which arise following chronic heavy workplace exposures to various mineral dusts, metal fumes, or following inhaled organic particulate reactions. Many occupational lung diseases could become irreversible; thus accurate diagnosis is mandatory to minimize dust exposure and consequently reduce damage to the respiratory system. Lung biopsy is usually required when exposure history is inconsistent with imaging, in case of unusual or new exposures, in case of unexpected malignancy, and in cases in which there are claims for personal injury and legal compensation. In this paper, we provide an overview of the most frequent occupational lung diseases with a focus on pathological diagnosis. This is a paper that summarizes the expert opinion from a group of European pathologists, together with contributions from other specialists who are crucial for the diagnosis and management of these diseases. Indeed, tight collaboration of all specialists involved in the workup is mandatory as many occupational lung diseases are misdiagnosed or go unrecognized. This document provides a guide for pathologists in practice to facilitate the accurate diagnosis of occupational lung disease. The review article reports relevant topics discussed during an educational course held by expert pathologists, active members of the Pulmonary Pathology Working Group of the European Society of Pathology. The course was endorsed by the University of Padova as a "winter school" (selected project in the call for "Shaping a World-class University" 2022).

Implementing Ecological Momentary Assessment in Audiological Research: Opportunities and Challenges.

Ecological momentary assessment (EMA) is a way to evaluate experiences in everyday life. It is a powerful research tool but can be complex and challenging for beginners. Application of EMA in audiological research brings with it opportunities and challenges that differ from other research disciplines. This tutorial discusses important considerations when conducting EMA studies in hearing care. While more research is needed to develop specific guidelines for the various potential applications of EMA in hearing research, we hope this article can alert hearing researchers new to EMA to pitfalls when using EMA and help strengthen their study design. The current article elaborates study design details, such as choice of participants, representativeness of the study period for participants' lives, and balancing participant burden with data requirements. Mobile devices and sensors to collect objective data on the acoustic situation are reviewed alongside different possibilities for EMA setups ranging from online questionnaires paired with a timer to proprietary apps that also have access to parameters of a hearing device. In addition to considerations for survey design, a list of questionnaire items from previous studies is provided. For each item, an example and a list of references are given. EMA typically provides data sets that are rich but also challenging in that they are noisy, and there is often unequal amount of data between participants. After recommendations on how to check the data for compliance, reactivity, and careless responses, methods for statistical analysis on the individual level and on the group level are discussed including special methods for direct comparison of hearing device programs.

Auditing the representation of hormonal contraceptives in studies assessing exercise performance in women.

Hormonal contraceptive (HC) users have a different ovarian hormonal profile compared to eumenorrheic women. Due to the prevalence of HC use amongst sportswomen, there has been increased research efforts to understand their impact on exercise performance. The aim was to audit this research. Studies identified were assessed for HC type, athlete calibre, performance outcome, study design, and quality of methodological control regarding ovarian hormonal profiles. Sixty-eight different HCs were reported across 61 studies. Monophasic combined oral contraceptive (OCP) pills represented 60% of HCs, followed by other pills [34%, phasic-combined, progestogen-only, and un-specified], phasic and long acting reversible contraceptives [5%, vaginal ring, patch, implant, injection, intrauterine system] and unspecified HCs (1%). Eleven percent of participants using HCs were classified as highly trained or elite/international with no participants being classed as world class. Whilst the number of studies involving HCs has increased two-fold over the past decade, the number of studies ranked as gold standard has not increased (HC; 2003-57%, 2011-55%, 2022-43%. OCP; 2003-14%, 2011-17%, 2022-12%). Future research assessing HCs and exercise performance should adopt high-quality research designs and include a broader range of HCs in highly trained to world-class populations to increase the reach and impact of research in this area.

Implementation of an ISO 15189 accredited next generation sequencing service for cell-free total nucleic acid (cfTNA) analysis to facilitate driver mutation reporting in blood: the experience of a clinical diagnostic laboratory.

AIMS: Next generation sequencing (NGS) on tumour tissue is integral to the delivery of personalised medicine and targeted therapy. NGS on liquid biopsy, a much less invasive technology, is an emerging clinical tool that has rapidly expanded clinical utility. Gene mutations in cell-free total nucleic acids (cfTNA) circulating in the blood are representative of whole tumour biology and can reveal different mutations from different tumour sites, thus addressing tumour heterogeneity challenges. METHODS: The novel Ion Torrent Genexus NGS system with automated sample preparation, onboard library preparation, templating, sequencing, data analysis and Oncomine Reporter software was used. cfTNA extracted from plasma was verified with the targeted pan-cancer (~50 genes) Oncomine Precision Assay (OPA). Assessment criteria included analytical sensitivity, specificity, limits of detection (LOD), accuracy, repeatability, reproducibility and the establishment of performance metrics. RESULTS: An ISO 15189 accredited, minimally invasive cfTNA NGS diagnostic service has been implemented. High sensitivity (>83%) and specificity between plasma and tissue were observed. A sequencing LOD of 1.2% was achieved when the depth of coverage was >22 000×. A reduction (>68%) in turnaround time (TAT) of liquid biopsy results was achieved: 5 days TAT for in-house analysis from sample receipt to a final report issued to oncologists as compared with >15 days from reference laboratories. CONCLUSION: Tumour-derived somatic variants can now be reliably assessed from plasma to provide minimally invasive tumour profiling. Successful implementation of this accredited service resulted in:Appropriate molecular profiling of patients where tumour tissue is unavailable or inaccessible.Rapid TAT of plasma NGS results.

Minimal influence of the menstrual cycle or hormonal contraceptives on performance in female rugby league athletes.

We examined performance across one menstrual cycle (MC) and 3 weeks of hormonal contraceptives (HC) use to identify whether known fluctuations in estrogen and progesterone/progestin are associated with functional performance changes. National Rugby League Indigenous Women's Academy athletes [n = 11 naturally menstruating (NM), n = 13 using HC] completed performance tests [countermovement jump (CMJ), squat jump (SJ), isometric mid-thigh pull, 20 m sprint, power pass and Stroop test] during three phases of a MC or three weeks of HC usage, confirmed through ovulation tests alongside serum estrogen and progesterone concentrations. MC phase or HC use did not influence jump height, peak force, sprint time, distance thrown or Stroop effect. However, there were small variations in kinetic and kinematic CMJ/SJ outputs. NM athletes produced greater mean concentric power in MC phase four than one [+0.41 W·kg-1 (+16.8%), p = 0.021] during the CMJ, alongside greater impulse at 50 ms at phase one than four [+1.7 N·s (+4.7%), p = 0.031] during the SJ, without differences between tests for HC users. Among NM athletes, estradiol negatively correlated with mean velocity and power (r = -0.44 to -0.50, p < 0.047), progesterone positively correlated with contraction time (r = 0.45, p = 0.045), and both negatively correlated with the rate of force development and impulse (r = -0.45 to -0.64, p < 0.043) during the SJ. During the CMJ, estradiol positively correlated to 200 ms impulse (r = 0.45, p = 0.049) and progesterone to mean power (r = 0.51, p = 0.021). Evidence of changes in testing performance across a MC, or during active HC use, is insufficient to justify "phase-based testing"; however, kinetic or kinematic outputs may be altered in NM athletes.

A Cautionary Note on Pembrolizumab use in Patients with Ascending Aortic Aneurysms.

Case description: We describe a case of a patient treated with pembrolizumab (an immune checkpoint inhibitor) for metastatic scalp melanoma. He had a previous history of colorectal cancer, prostatic cancer and chronic polymyalgia rheumatica. The patient was known to have a stable ascending aortic aneurysm of 4.5 cm. However, he developed a rapid expansion of the ascending aortic aneurysm with the size crossing the threshold for surgery. The patient was referred to the cardiothoracic surgery service for intervention and he subsequently underwent surgery. The patient was electively admitted one week later for resection of aortic aneurysm, aortoplasty and external graft fixation. Pathologically, gross evidence of dissection was not identified; however, the histological analysis of the media showed laminar medial necrosis, multifocal in nature, with occasional clusters of histiocytic cells appreciated at their edge reminiscent of that seen in an inflammatory aortitis (granulomatous/giant cell type). Discussion: Immune checkpoint inhibitor-induced aortitis is becoming increasingly evident, and its presentation can vary. It has been discovered incidentally on surveillance imaging with the use of nivolumab. In other cases, patients have been symptomatic to severely symptomatic. Atezolizumab with carboplatin and etoposide has been reported to cause abdominal aortitis which was responsive to corticosteroids and subsequent discontinuation of atezolizumab. Pembrolizumab has been linked to a case of transverse aortic arch aortitis. In our case, the inflammatory aortitis due to pembrolizumab was the cause of the rapid expansion of the ascending aortic aneurysm. Conclusion: Patients with known aortic aneurysms should undergo careful surveillance when commencing immune-checkpoint inhibitor therapy. LEARNING POINTS: Immune checkpoint inhibitors are being increasingly used in the treatment of metastatic malignancy. However, they are a relatively new group of medications, and the side effect profile of each is yet to be fully recognised. Aortitis has occurred with several different immune checkpoint inhibitors.Patients with known aortic aneurysms should undergo careful surveillance when commencing immune checkpoint inhibitors.All interventional therapeutic options should be considered early in these patients on the development of aneurysmal expansion.

The Current State of Evidence Regarding Audiologist-Provided Cognitive Behavioural Therapy for the Management of Tinnitus: A Scoping Review.

BACKGROUND: Cognitive behavioural therapy (CBT) for tinnitus management is effective and widely recommended by national and international practice guidelines. However, all the evidence for CBT so far has come from Psychologist-led programs, and the potential role of Audiologists in providing CBT for tinnitus remains an important consideration. OBJECTIVES: This study sets out to systematically map the body of literature relating to Audiologist-provided CBT for tinnitus, in order to summarise the current state of evidence and determine directions for future research. ELIGIBILITY CRITERIA: Sources were eligible for inclusion if they addressed the concept of Audiologist-provided CBT. No restrictions were imposed on the date of publication. Only sources published in English were included. SOURCES OF EVIDENCE: A wide range of primary and secondary literature sources were sought. CHARTING METHODS: Data from included sources were charted systematically using a pre-designed data charting form. RESULTS: Of the 267 identified sources, 30 were included in this review. This included both primary and secondary literature sources. Primary sources were compared and showed variation across Audiologist-provided CBT programs both in terms of procedural details and from a research standpoint. CONCLUSIONS: A growing body of evidence has addressed the concept of Audiologist-provided CBT. Directions for future research include further primary research with an increased focus on face-to-face Audiologist-provided CBT, and a comparison of the outcomes of Audiologist-provided vs. Psychologist-provided CBT.

Day-to-Day Glycemic Variability Using Continuous Glucose Monitors in Endurance Athletes.

OBJECTIVES: The application of continuous glucose monitors (CGMs) to measure interstitial glucose in athletic populations is limited by the lack of accepted athlete-specific reference values. The aim of this study was to develop athlete-specific reference ranges for glycemic variability under standardized diet and exercise conditions. METHODS: A total of 12 elite racewalkers (n = 7 men, 22.4 ± 3.5 years, VO2max 61.6 ± 7.3 mL kg-1 min-1) completed two 4-d trials separated by 4-d. Athletes were provided a high-energy, high-carbohydrate diet (225 ± 1.6 kJ kg-1 day-1, 8.4 ± 0.3 g kg-1 day-1 carbohydrate) and completed standardized daily exercise. The timing of food consumed and exercise undertaken were matched each day across the 4-d trials. Interstitial glucose data were collected via Freestyle Libre 2 CGMs. Glycemic variability was calculated as the mean amplitude of glycemic excursions (MAGEs), mean of daily differences (MODD), and standard deviation (SD). RESULTS: Twenty-four hour MODD, MAGE, and SD for interstitial glucose were 12.6 ± 1.8 mg/dL (0.7 ± 0.1 mmol/L), 36.0 ± 5.4 mg/dL (2.0 ± 0.3 mmol/L), and 16.2 ± 1.8 mg/dL (0.9 ± 0.1 mmol/L), respectively. Twenty-four hour mean glucose (MG; 102.6 ± 5.4 mg/dL [5.7 ± 0.3 mmol/L]) was higher than overnight (91.8 ± 5.4 mg/dL [5.1 ± 0.3 mmol/L]; P < .0001) and was lower in women than men (99.0 ± 3.6 mg/dL [5.5 ± 0.2 mmol/L] vs 104.4 ± 3.6 mg/dL [5.8 ± 0.2 mmol/L]; P = .059, d = 1.4). CONCLUSIONS: This study provides reference indices under standardized diet and exercise conditions for glycemic variability derived from CGMs in endurance athletes which are similar than previously reported for healthy individuals, despite strenuous daily training and a high daily energy and carbohydrate diet.

Effect of Menstrual Cycle Phase and Hormonal Contraceptives on Resting Metabolic Rate and Body Composition.

The cyclical changes in sex hormones across the menstrual cycle (MC) are associated with various biological changes that may alter resting metabolic rate (RMR) and body composition estimates. Hormonal contraceptive (HC) use must also be considered given their impact on endogenous sex hormone concentrations and synchronous exogenous profiles. The purpose of this study was to determine if RMR and dual-energy X-ray absorptiometry body composition estimates change across the MC and differ compared with HC users. This was accomplished during a 5-week training camp involving naturally cycling athletes (n = 11) and HC users (n = 7 subdermal progestin implant, n = 4 combined monophasic oral contraceptive pill, n = 1 injection) from the National Rugby League Indigenous Women's Academy. MC phase was retrospectively confirmed via serum estradiol and progesterone concentrations and a positive ovulation test. HC users had serum estradiol and progesterone concentrations assessed at the time point of testing. Results were analyzed using general linear mixed model. There was no effect of MC phase on absolute RMR (p = .877), relative RMR (p = .957), or dual-energy X-ray absorptiometry body composition estimates (p > .05). There was no effect of HC use on absolute RMR (p = .069), relative RMR (p = .679), or fat mass estimates (p = .766), but HC users had a greater fat-free mass and lean body mass than naturally cycling athletes (p = .028). Our findings suggest that RMR and dual-energy X-ray absorptiometry body composition estimates do not significantly differ due to changes in sex hormones in a group of athletes, and measurements can be compared between MC phases or with HC usage without variations in sex hormones causing additional noise.