Factors Associated with Veteran Self-Reported Use of Digital Health Devices.

BACKGROUND: Digital health devices (DHDs), technologies designed to gather, monitor, and sometimes share data about health-related behaviors or symptoms, can support the prevention or management of chronic conditions. DHDs range in complexity and utility, from tracking lifestyle behaviors (e.g., pedometer) to more sophisticated biometric data collection for disease self-management (e.g., glucometers). Despite these positive health benefits, supporting adoption and sustained use of DHDs remains a challenge. OBJECTIVE: This analysis examined the prevalence of, and factors associated with, DHD use within the Veterans Health Administration (VHA). DESIGN: National survey. PARTICIPANTS: Veterans who receive VHA care and are active secure messaging users. MAIN MEASURES: Demographics, access to technology, perceptions of using health technologies, and use of lifestyle monitoring and self-management DHDs. RESULTS: Among respondents, 87% were current or past users of at least one DHD, and 58% were provided a DHD by VHA. Respondents 65 + years were less likely to use a lifestyle monitoring device (AOR 0.57, 95% CI [0.39, 0.81], P = .002), but more likely to use a self-management device (AOR 1.69, 95% [1.10, 2.59], P = .016). Smartphone owners were more likely to use a lifestyle monitoring device (AOR 2.60, 95% CI [1.42, 4.75], P = .002) and a self-management device (AOR 1.83, 95% CI [1.04, 3.23], P = .037). CONCLUSIONS: The current analysis describes the types of DHDs that are being adopted by Veterans and factors associated with their adoption. Results suggest that various factors influence adoption, including age, access to technology, and health status, and that these relationships may differ based on the functionalities of the device. VHA provision of devices was frequent among device users. Providing Veterans with DHDs and the training needed to use them may be important factors in facilitating device adoption. Taken together, this knowledge can inform future implementation efforts, and next steps to support patient-team decision making about DHD use.

Veteran Preferences and Willingness to Share Patient-Generated Health Data.

BACKGROUND: Technologies, including mobile health applications (apps) and wearables, offer new potential for gathering patient-generated health data (PGHD) from patients; however, little is known about patient preferences for and willingness to collect and share PGHD with their providers and healthcare systems. OBJECTIVE: Describe how patients use their PGHD and factors important to patients when deciding whether to share PGHD with a healthcare system. DESIGN: Cross-sectional mailed longitudinal survey supplemented with administrative data within the Veterans Health Administration (VHA). SUBJECTS: National sample of Veterans who use VHA healthcare. MAIN MEASURES: Survey questions asked about demographics, willingness to use different devices to collect and share PGHD, what Veterans do with their PGHD, and factors important to Veterans when deciding whether to share PGHD with VHA. Administrative data provided information on Veteran health conditions. Multiple logistic regression models assessed factors associated with sharing PGHD with VHA. KEY RESULTS: Overall, 47% of our analytic cohort (n = 383/807) indicated that they share PGHD collected through apps or digital health devices with VHA. In adjusted logistic regression models, Veterans who believed the following factors were Very Important (versus Somewhat/Not At All Important) had higher odds of sharing PGHD with VHA: if their doctor (OR = 1.4; 95%CI, 1.0-2.0) or other healthcare team members (OR = 1.4; 95%CI, 1.0-1.9) recommended they do so; and knowing that their healthcare team would look at the data (OR = 1.4; 95%CI, 1.0-2.0) or use the information to inform their healthcare (OR = 1.5; 95%CI, 1.1-2.1). CONCLUSIONS: Our data suggest that healthcare team members can influence patient sharing of PGHD, as can a patient's knowledge that PGHD will be used in clinical practice. Efforts to increase the number of patients who share PGHD with a healthcare system may benefit from buy-in among healthcare team members, who appear to play an influential role in patient decisions to share data.

Improving Veteran Engagement with Virtual Care Technologies: a Veterans Health Administration State of the Art Conference Research Agenda.

Although the availability of virtual care technologies in the Veterans Health Administration (VHA) continues to expand, ensuring engagement with these technologies among Veterans remains a challenge. VHA Health Services Research & Development convened a Virtual Care State of The Art (SOTA) conference in May 2022 to create a research agenda for improving virtual care access, engagement, and outcomes. This article reports findings from the Virtual Care SOTA engagement workgroup, which comprised fourteen VHA subject matter experts representing VHA clinical care, research, administration, and operations. Workgroup members reviewed current evidence on factors and strategies that may affect Veteran engagement with virtual care technologies and generated key questions to address evidence gaps. The workgroup agreed that although extensive literature exists on factors that affect Veteran engagement, more work is needed to identify effective strategies to increase and sustain engagement. Workgroup members identified key priorities for research on Veteran engagement with virtual care technologies through a series of breakout discussion groups and ranking exercises. The top three priorities were to (1) understand the Veteran journey from active service to VHA enrollment and beyond, and when and how virtual care technologies can best be introduced along that journey to maximize engagement and promote seamless care; (2) utilize the meaningful relationships in a Veteran's life, including family, friends, peers, and other informal or formal caregivers, to support Veteran adoption and sustained use of virtual care technologies; and (3) test promising strategies in meaningful combinations to promote Veteran adoption and/or sustained use of virtual care technologies. Research in these priority areas has the potential to help VHA refine strategies to improve virtual care user engagement, and by extension, outcomes.

How do previously inactive individuals restructure their time to 'fit in' morning or evening exercise: a randomized controlled trial.

The objective of this study was to investigate changes in sedentary and active behaviors when previously inactive adults start exercising in the morning or evening. One-hundred adults with overweight or obesity (BMI ≥ 25 kg/m2) were recruited for a 12-week intervention and randomized to one of three groups: (i) morning exercise (AMEx; 0600-0900); (ii) evening exercise (PMEx; 1600-1900); or (iii) waitlist control. AMEx and PMEx were prescribed self-paced aerobic exercise to achieve a weekly total of 250 min via a combination of supervised and unsupervised training. Sedentary and active behavior times were measured at baseline, mid- and post-intervention using the multimedia activity recall for children and adults. Time spent engaging in physical activity was significantly increased from baseline at both mid- (+ 14-22 min·day-1) and post-intervention (+ 12-19 min·day-1), for AMEx and PMEx. At 12-weeks, participants in both morning and evening exercise groups reported increased time spent Sleeping (+ 36 and + 20 min·day-1, respecitively), and reduced time spent watching TV/playing videogames (- 32 and - 25 min·day-1, respectively). In response to an exercise stimulus, previously inactive adults make encouraging modifications in how they use their time, and the patterns of change are similar with morning and evening exercise.

Estimating nitrate intake in the Australian diet: Design and validation of a food frequency questionnaire.

BACKGROUND: Dietary nitrates may play a role in mediating several key physiological processes impacting health and/or exercise performance. However, current methods for assessing dietary nitrate (NO3 - ) consumption are inadequate. The present study aimed to examine the dietary nitrate intake in a sample of 50 healthy adults, as well as test the validity of a purposefully developed food frequency questionnaire (FFQ). METHODS: Dietary nitrate intake was estimated over a week using (i) three 24-h dietary recalls; (ii) a short-term (7-day) FFQ; and (iii) a biomarker (urinary nitrate), in conjunction with a nitrate reference database. RESULTS: Daily dietary nitrate intake estimates were 130.94 mg (average of three 24-h recalls) and 180.62 mg (FFQ). The mean urinary NO3 - excretion was 1974.79 µmol day-1 (or 917.9 µmol L-1 ). Despite the difference between the two dietary assessment methods, there was a moderate positive correlation (r = 0.736, ρ < 0.001) between the two tools. There was also a positive correlation between urinary NO3 - and 24-h recall data (r = 0.632, ρ < 0.001), as well as between urinary NO3 - and FFQ (r = 0.579, ρ < 0.001). CONCLUSIONS: The ability to accurately estimate nitrate intakes depends on having suitable reference methods to estimate the concentrations of nitrate in the food supply, coupled with valid and reliable dietary assessment tools. Based on the findings from the present study, at an individual level, dietary recalls or records may be more accurate in estimating intakes of NO3 - . However, given the lower cost and time needed for administration relative to recalls, the FFQ has merit for estimating NO3 - intakes in health interventions, dietary surveys and surveillance programs.

Time course of human skeletal muscle nitrate and nitrite concentration changes following dietary nitrate ingestion.

Dietary nitrate (NO3-) ingestion can be beneficial for health and exercise performance. Recently, based on animal and limited human studies, a skeletal muscle NO3- reservoir has been suggested to be important in whole body nitric oxide (NO) homeostasis. The purpose of this study was to determine the time course of changes in human skeletal muscle NO3- concentration ([NO3-]) following the ingestion of dietary NO3-. Sixteen participants were allocated to either an experimental group (NIT: n = 11) which consumed a bolus of ∼1300 mg (12.8 mmol) potassium nitrate (KNO3), or a placebo group (PLA: n = 5) which consumed a bolus of potassium chloride (KCl). Biological samples (muscle (vastus lateralis), blood, saliva and urine) were collected shortly before NIT or PLA ingestion and at intervals over the course of the subsequent 24 h. At baseline, no differences were observed for muscle [NO3-] and [NO2-] between NIT and PLA (P > 0.05). In PLA, there were no changes in muscle [NO3-] or [NO2-] over time. In NIT, muscle [NO3-] was significantly elevated above baseline (54 ± 29 nmol/g) at 0.5 h, reached a peak at 3 h (181 ± 128 nmol/g), and was not different to baseline from 9 h onwards (P > 0.05). Muscle [NO2-] did not change significantly over time. Following ingestion of a bolus of dietary NO3-, skeletal muscle [NO3-] increases rapidly, reaches a peak at ∼3 h and subsequently declines towards baseline values. Following dietary NO3- ingestion, human m. vastus lateralis [NO3-] expressed a slightly delayed pharmacokinetic profile compared to plasma [NO3-].

Nitrate, nitrite and nitrosamines in the global food supply.

Inorganic nitrate provided by either nitrate salts or food supplements may improve cardiometabolic health. However, current methods to assess dietary nitrate, nitrite and nitrosamine consumption are inadequate. The purpose of this study was to develop a reference database to estimate the levels of nitrate, nitrite and nitrosamines in the global food supply. A systematic literature search was undertaken; of the 5,747 articles screened, 448 met the inclusion criteria. The final database included data for 1,980 food and beverages from 65 different countries. There were 5,105 unique records for nitrate, 2,707 for nitrite, and 954 for nitrosamine. For ease of use, data were sorted into 12 categories; regarding nitrate and nitrite concentrations in food and beverages, 'vegetables and herbs' were most reported in the literature (n = 3,268 and n = 1,200, respectively). For nitrosamines, 'protein foods of animal origin' were most reported (n = 398 records). This database will allow researchers and practitioners to confidently estimate dietary intake of nitrate, nitrite and nitrosamines. When paired with health data, our database can be used to investigate associations between nitrate intake and health outcomes, and/or exercise performance and could support the development of key dietary nitrate intake guidelines.

Independent and interactive associations of dietary nitrate and salt intake with blood pressure and cognitive function: a cross-sectional analysis in the InCHIANTI study.

Blood pressure (BP) control is a key target for interventions to reduce cognitive decline. This cross-sectional study explored associations between objective (24-hour urine excretion) and subjective (food frequency questionnaire [FFQ]) measures of dietary sodium and nitrate intakes with cognitive function and resting BP in the InCHIANTI cohort. Baseline data from 989 participants aged >50 years were included. In fully adjusted models, participants with concurrent high nitrate and low sodium (Odds Ratio (OR)=0.49, 95%CI 0.32-0.76, p = 0.001) and high nitrate and high sodium (OR = 0.49, 95%CI 0.32-0.77, p = 0.002) 24-hour urinary concentrations had lower odds of high BP than participants with low nitrate and high sodium concentrations. We found no significant associations between sodium and nitrate intakes (24-hour urinary concentrations and FFQ) and poor cognitive performance. Urinary nitrate excretion was associated with lower BP and results appeared to be independent of sodium intake. Further analyses in longitudinal studies are required to substantiate these findings.

The impact of dietary supplements on blood pressure in older adults: A network meta-analysis of randomized controlled trials.

Purpose: The prevalence of hypertension (HTN) increases with age and there is a need for effective, evidence-based treatments for HTN among older adults. The objective of this study was to perform a network meta-analysis to evaluate the effectiveness of different forms of nutritional supplementation on reducing blood pressure in older adults. Methods: A systematic review using PubMed and Clinical Key was performed to identify randomized controlled trials (RCTs) evaluating the effects of dietary supplements on blood pressure in adults older than 65 years of age. Network meta-analysis (NMA) was used to compare and rank the effects of different supplements on systolic (sBP), diastolic (dBP), and mean (mBP) blood pressure. Supplements were ranked according to P score. Meta-regressions were conducted to examine whether treatment effects were moderated by baseline BP and supplementation duration. Findings: We identified 144 relevant studies in the literature, twelve of which met criteria for inclusion in NMA. The included studies were published between 2003 and 2022. In reducing sBP, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), inorganic nitrates, tart cherry juice, and vitamin D supplementation were more effective than placebo, and the effect of tart cherry juice outranked that of vitamin D, vitamin E, and vitamin K2. In reducing dBP, inorganic nitrates, DHA and EPA, protein, resveratrol, and vitamin D supplementation were more effective than placebo, and the effect of resveratrol outranked that of tart cherry juice, vitamin D, vitamin E, and vitamin K2. However, the effects of tart cherry juice on sBP and resveratrol on dPB were smaller than the pooled effect of placebo, and none of the pairwise differences between the effects of examined supplements were statistically significant. Caution is needed when interpreting these results given concerns about the risk of bias assessed in seven of the twelve studies included in this analysis.

Dietary nitrate intake and association with markers of cardiometabolic risk in Iranian female adolescents.

Dietary nitrates are thought to confer several cardiometabolic health benefits, including improvements in blood pressure and the plasma lipid profile. However, existing data from Iran is conflicting and there is a dearth of literature focusing on non-adult populations. A total of 988 adolescent girls were recruited from schools in different areas of Mashhad and Sabzevar, Iran. Dietary nitrate intake was assessed using a food frequency questionnaire and participants were categorized into quartiles based on this. Differences in participant characteristics between quartiles were assessed using one-way ANOVA and associations between total nitrate intake, nitrate intake from vegetables and cardiometabolic risk markers (blood lipid profile, fasting blood glucose, systolic and diastolic blood pressure) were assessed using linear regression. Nitrate intake from vegetables was positively correlated with triglycerides, even after adjusting for several variables (ß = 0.086, 95% CI = 0.002-0.097; P = 0.043). Total nitrate intake was also significantly positively associated with serum triglycerides (ß = 0.097, 95% CI = 0.010-0.084; P = 0.012); however, this relationship disappeared after adjusting for several variables. Significant interaction effects were observed between total nitrate intake, nitrate intake from vegetables, and vitamin C upon triglycerides (P < 0.01). No significant relationships were found between total nitrate intake, nitrate intake from vegetables, and other cardiometabolic risk markers. Our findings suggest there may be neutral or possibly detrimental cardiovascular effects of dietary nitrate and/or vitamin C intake which are not in agreement with contemporary literature and warrant further investigation.

Veteran Experiences With an mHealth App to Support Measurement-Based Mental Health Care: Results From a Mixed Methods Evaluation.

BACKGROUND: Mental health conditions are highly prevalent among US veterans. The Veterans Health Administration (VHA) is committed to enhancing mental health care through the integration of measurement-based care (MBC) practices, guided by its Collect-Share-Act model. Incorporating the use of remote mobile apps may further support the implementation of MBC for mental health care. OBJECTIVE: This study aims to evaluate veteran experiences with Mental Health Checkup (MHC), a VHA mobile app to support remote MBC for mental health. METHODS: Our mixed methods sequential explanatory evaluation encompassed mailed surveys with veterans who used MHC and follow-up semistructured interviews with a subset of survey respondents. We analyzed survey data using descriptive statistics. We then compared responses between veterans who indicated having used MHC for ≥3 versus <3 months using χ2 tests. We analyzed interview data using thematic analysis. RESULTS: We received 533 surveys (533/2631, for a 20% response rate) and completed 20 interviews. Findings from these data supported one another and highlighted 4 key themes. (1) The MHC app had positive impacts on care processes for veterans: a majority of MHC users overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed or strongly agreed that using MHC helped them be more engaged in their health and health care (169/262, 65%), make decisions about their treatment (157/262, 60%), and set goals related to their health and health care (156/262, 60%). Similarly, interviewees described that visualizing progress through graphs of their assessment data over time motivated them to continue therapy and increased self-awareness. (2) A majority of respondents overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed/strongly agreed that using MHC enhanced their communication (112/164, 68% versus 51/98, 52%; P=.009) and rapport (95/164, 58% versus 42/98, 43%; P=.02) with their VHA providers. Likewise, interviewees described how MHC helped focus therapy time and facilitated trust. (3) However, veterans also endorsed some challenges using MHC. Among respondents overall, these included difficulty understanding graphs of their assessment data (102/245, 42%), not receiving enough training on the app (73/259, 28%), and not being able to change responses to assessment questions (72/256, 28%). (4) Interviewees offered suggestions for improving the app (eg, facilitating ease of log-in, offering additional reminder features) and for increasing adoption (eg, marketing the app and its potential advantages for veterans receiving mental health care). CONCLUSIONS: Although experiences with the MHC app varied, veterans were positive overall about its use. Veterans described associations between the use of MHC and engagement in their own care, self-management, and interactions with their VHA mental health providers. Findings support the potential of MHC as a technology capable of supporting the VHA's Collect-Share-Act model of MBC.

Mental health provider perspectives on a mobile health application to support remote measurement-based care: Challenges and impacts.

Measurement-based care (MBC) comprises collecting patient-reported outcomes data using validated assessments and using that information to support treatment. The Veterans Health Administration (VHA) has developed technology platforms to support MBC, including the Mental Health Checkup (MHC) mobile health application (app). Our objective was to examine VHA mental health provider perspectives on the MHC app. We completed a mixed-methods, sequential explanatory evaluation of MHC. We surveyed 284 VHA mental health providers who used MHC, then conducted semistructured telephone interviews with a purposefully selected subset of survey respondents (n = 20). Approximately half of survey respondents agreed that MHC allowed them to collect assessment data from veterans more frequently than before (51%) and that they more frequently discussed assessment results with veterans because of MHC (50%) and used those results to inform goal-setting discussions (50%) and treatment decision making (51%). Bivariate analyses indicated a positive relationship between frequency of MHC use and the aforementioned impacts on care. Interview data conveyed both advantages (e.g., increased treatment efficiency, improved treatment decision making) and challenges (e.g., limited assessment availability, difficulties engaging veterans in completing assessments through the app) to using MHC. This evaluation demonstrated how MHC supported providers working to implement MBC. The app enhanced their ability to reach and engage veterans and incorporate assessment data into clinical encounters. Still, many did not perceive that MHC was impactful on mental health care delivery; given that providers who used MHC more frequently reported more positive impressions of MHC, this may be related to how frequently they used the app. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Assessment of dietary nitrate supplementation: prevalence of use, knowledge, attitudes and beliefs among active Australians.

Introduction: Use of nitrate as a dietary supplement has gained popularity among athletes and recreationally active individuals to enhance exercise performance. However, the prevalence and patterns of use, and knowledge of nitrate as a dietary supplement are unknown. Methods: Individuals (≥16y) completed a 42-item online questionnaire to collect (i) sociodemographic information; (ii) participation in activity and sport; (iii) nitrate supplementation use and reasons; (iv) attitudes and beliefs regarding information sources and the safety of nitrate as a dietary supplement; and (v) knowledge of dietary nitrate supplements. Results: In total, 1,404 active adults (66% female) took part in the study. Only about one in 10 respondents (11.9%) reported they had consumed dietary nitrate ("users") in the past, most commonly as beetroot juice (31.3%). Over two-thirds (69.4%) of users could not correctly identify the correct timing of intake relative to performance time to best improve exercise performance, and most users (82.3%) were unsure of the contraindications to oral consumption of dietary nitrate supplements. Only 3.9% of users experienced adverse effects after ingesting dietary nitrate supplements. Among non-users, the most common reasons respondents selected for not using dietary nitrate supplements were "I do not think I need to" (70.2%) and "I have never thought about it" (69.2%). Discussion: There is evidence to support the efficacy of dietary nitrate intake in improving exercise performance. However, findings from this study suggest dietary nitrate is under-utilized. Educational messages that target dietary nitrate consumption should be targeted toward nutritionists, coaches, and exercise physiologists to bridge the gap between knowledge-to-practice.

Understanding Adoption and Preliminary Effectiveness of a Mobile App for Chronic Pain Management Among US Military Veterans: Pre-Post Mixed Methods Evaluation.

BACKGROUND: The Veterans Health Administration Pain Coach mobile health app was developed to support veterans with chronic pain. OBJECTIVE: Our objective was to evaluate early user experiences with the Pain Coach app and preliminary impacts of app use on pain-related outcomes. METHODS: Following a sequential, explanatory, mixed methods design, we mailed surveys to veterans at 2 time points with an outreach program in between and conducted semistructured interviews with a subsample of survey respondents. We analyzed survey data using descriptive statistics among veterans who completed both surveys and examined differences in key outcomes using paired samples t tests. We analyzed semistructured interview data using thematic analysis. RESULTS: Of 1507 veterans invited and eligible to complete the baseline survey, we received responses from 393 (26.1%). These veterans received our outreach program; 236 (236/393, 60.1%) completed follow-up surveys. We conducted interviews with 10 app users and 10 nonusers. Among survey respondents, 10.2% (24/236) used Pain Coach, and 58% (14/24) reported it was easy to use, though interviews identified various app usability issues. Veterans who used Pain Coach reported greater pain self-efficacy (mean 23.1 vs mean 16.6; P=.01) and lower pain interference (mean 34.6 vs mean 31.8; P=.03) after (vs before) use. The most frequent reason veterans reported for not using the app was that their health care team had not discussed it with them (96/212, 45.3%). CONCLUSIONS: Our findings suggest that future efforts to increase adoption of Pain Coach and other mobile apps among veterans should include health care team endorsement. Our findings regarding the impact of Pain Coach use on outcomes warrant further study.

Factors Associated With Self-reported Use of Web and Mobile Health Apps Among US Military Veterans: Cross-sectional Survey.

BACKGROUND: Despite their prevalence and reported patient interest in their use, uptake of health-related apps is limited. The Veterans Health Administration (VHA) has developed a variety of apps to support veterans; however, uptake remains low nationally. OBJECTIVE: We examined the prevalence of VHA health-related app use and how veterans learned about these apps in order to identify factors associated with their use. METHODS: As part of a VHA quality improvement initiative, we recruited a national cohort of veterans to obtain feedback on their use of technology for health and collected data from them via a cross-sectional survey. The survey data were supplemented with VHA administrative data. We used descriptive statistics to examine demographic and health characteristics, health-related technology use, and how veterans learned about apps. We assessed factors associated with app use using bivariate analyses and multiple logistic regression models. RESULTS: We had complete data on 1259 veterans. A majority of the sample was male (1069/1259, 84.9%), aged older than 65 years (740/1259, 58.8%), White (1086/1259, 86.3%), and non-Hispanic (1218/1259, 96.7%). Most respondents (1125/1259, 89.4%) reported being very comfortable and confident using computers, over half (675/1259, 53.6%) reported being an early adopter of technology, and almost half (595/1259, 47.3%) reported having used a VHA health-related app. Just over one-third (435/1259, 34.6%) reported that their VHA care team members encouraged them to use health-related apps. Respondents reported learning about available VHA health-related apps by reading about them on the VHA's patient portal (468/1259, 37.2%), being told about them by their VHA health care team (316/1259, 25.1%), and reading about them on the VHA's website (139/1259, 11%). Veterans who self-reported having used VHA health-related apps were more likely to receive care at the VHA (OR [odds ratio] 1.3, 95% CI 1.0-1.7), be in worse health (as assessed by Hierarchical Condition Community score; OR 1.1, 95% CI 1.0-1.2), report owning a desktop or laptop computer (OR 1.8, 95% CI 1.1-3.1), have posttraumatic stress disorder (OR 1.4, 95% CI 1.1-1.9), and report having VHA health care team members encourage them to use the apps (OR 2.7, 95% CI 2.1-3.4). CONCLUSIONS: We found strong associations between self-reported use by veterans of VHA health-related apps and multiple variables in our survey. The strongest association was observed between a veteran self-reporting app use and having received encouragement from their VHA health care team to use the apps. Veterans who reported receiving encouragement from their VHA care team members had nearly 3 times higher odds of using VHA apps than veterans who did not report receiving such encouragement. Our results add to growing evidence suggesting that endorsement of apps by a health care system or health care team can positively impact patient uptake and use.

Acceptability and Feasibility of a 13-Week Pilot Randomised Controlled Trial Testing the Effects of Incremental Doses of Beetroot Juice in Overweight and Obese Older Adults.

Nitrate-rich food can increase nitric oxide production and improve vascular and brain functions. This study examines the feasibility of a randomised controlled trial (RCT) testing the effects of prolonged consumption of different doses of dietary nitrate (NO3-) in the form of beetroot juice (BJ) in overweight and obese older participants. A single-blind, four-arm parallel pilot RCT was conducted in 62 overweight and obese (30.4 ± 4 kg/m2) older participants (mean ± standard deviation (SD), 66 ± 4 years). Participants were randomized to: (1) high-NO3- (HN: 2 × 70 mL BJ/day) (2) medium-NO3- (MN: 70 mL BJ/day), (3) low-NO3- (LN: 70 mL BJ on alternate days) or (4) Placebo (PL: 70 mL of NO3--depleted BJ on alternate days), for 13 weeks. Compliance was checked by a daily log of consumed BJ, NO3- intake, and by measuring NO3- and NO2- concentrations in plasma, saliva, and urine samples. Fifty participants completed the study. Self-reported compliance to the interventions was >90%. There were significant positive linear relationships between NO3- dose and the increase in plasma and urinary NO3- concentration (R2 = 0.71, P < 0.001 and R2 = 0.46 P < 0.001, respectively), but relationships between NO3- dose and changes in salivary NO3- and NO2- were non-linear (R2 = 0.35, P = 0.002 and R2 = 0.23, P = 0.007, respectively). The results confirm the feasibility of prolonged BJ supplementation in older overweight and obese adults.

Novel route to size-controlled synthesis of MnFe2O4@MOF core-shell nanoparticles.

Nanoscale metal-organic framework (nMOF) is a distinctive type of crystalline compounds that consists of metal ions or clusters coordinated to organic ligands. This hybrid material has attracted fast-growing attention due to its tunable pore sizes, remarkably large surface areas, and high selectivity in uptaking small molecules. In this paper, we successfully developed a novel approach for synthesizing a core-shell structure with MIL-88B-4CH3 as a tunable nMOF shell and MnFe2O4 as a magnetic core. We controlled the growth of the core-shell particles by introducing different acetic acid concentrations and with varied reaction time. Acetic acid works as a modulating agent that allows for nucleation rate control, leading to tailored particle size. Our results show an increase in the particle size with increasing acetic acid concentration or reaction time. This study provides a valuable methodology for synthesis of core-shell nanoparticles with controlled sizes based on nMOF platforms.

Supra-Versus Submaximal Cycle Ergometer Verification of VO2max in Males and Females.

This study was designed to determine the optimal intensity for verification phase testing (VP) in healthy, young adults. Thirty one young, active participants (16 females) completed a cycle ergometer graded exercise test (GXT) VO2max test and 4 VP tests at 80, 90, 100, and 105% of the maximum wattage achieved during the GXT. GXT and VP VO2max values showed a significant test x sex interaction (p = 0.02). The males elicited significantly higher VO2max values during the GXT, 80%, and 90% when compared to the 105%, (105 vs. GXT: p = 0.05; 105% vs. 80%: p < 0.01; 105% vs. 90%: p = 0.02). There were no significant differences in VO2max across the tests in the females (p > 0.05); 80% of the males achieved their highest VP VO2max during a submaximal VP test compared to only 37.5% of the females. A secondary study conducted showed excellent reliability (ICCs > 0.90) and low variation (CVs < 3%) for the 90% VP. Our findings show that a submaximal verification phase intensity is ideal for young healthy males to elicit the highest VO2max during cycle ergometer testing. For females, a range of intensities (80-105%) produce similar VO2max values. However, the 80% VP yields an unnecessarily high time to exhaustion.

Protocol and recruitment results from a 13-week randomized controlled trial comparing the effects of different doses of nitrate-rich beetroot juice on cognition, cerebral blood flow and peripheral vascular function in overweight and obese older people.

BACKGROUND: Nitrate-rich food can increase NO production and may induce positive effects on brain function. This study examined the feasibility of a randomized clinical trial (RCT) testing the effects of prolonged consumption of incremental doses of dietary nitrate (NO3 -) in overweight and obese older participants. Secondary aims tested dose-dependent changes in cognitive, vascular and pulmonary functions and cerebral blood flow (CBF). METHODS: This was a single blind, four-arm parallel RCT conducted in 60 overweight and obese older participants. Eligible participants were randomized to:1) high NO3 - (140 ml of beetroot juice (BJ) per day, ~800 mg of NO3 -/day), 2) moderate NO3 - (70 ml of BJ per day, ~400 mg of NO3 -/day), 3) low NO3 - (70 ml on alternate days, ~400 mg of NO3 -) or 4) NO3 - depleted (70 ml on alternate days, ~0.001 mg of NO3). Measurements of cognitive, vascular and pulmonary functions and CBF were conducted at baseline and 13-weeks NO3 - intake was assessed by six 24-h recalls, and by measuring NO3 - intake biomarkers. Feasibility was assessed by obtaining qualitative feedback and evaluating trial recruitment, retention, compliance with study visits and measurement protocols. RESULTS: Participant recruitment started in July 2018 and ended in April 2019. Of all the recruitment strategies that were used, advertisement of the study via Facebook generated the highest response rate. Sixty-two participants consented and were enrolled. Overall, characteristics of included participants matched our recruitment criteria. CONCLUSION: The findings from this study provide evidence of the acceptability and feasibility of an intervention investigating the effects of incremental doses of high-nitrate BJ over a prolonged period. TRIAL REGISTRATION: The intervention study was registered with clinical trial ISRCTN registry (ISRCTN14746723) on 27 December 2018.