Structured lifestyle modification as an adjunct to obesity pharmacotherapy: there is much to learn.

We are at the start of an exciting new era of very effective pharmacotherapy for patients with obesity, with the latest generation of drugs approaching the efficacy of obesity surgery. Clinical trials of obesity drugs tend to emphasise the importance of participation in some form of structured lifestyle intervention for all trial participants. This usually consists of advice to reduce calorie intake and increase moderate to vigorous physical activity. There is strong evidence that structured lifestyle modification programmes improve health in patients with obesity and related disorders. However, there is no specific evidence that they improve the response to obesity medications. This is because of the way that drug trials for patients with obesity have traditionally been designed, with participants in the active drug treatment group being compared to participants on placebo drug treatment, but with both groups always receiving the same structured lifestyle intervention. While this approach is entirely reasonable, it makes it impossible to draw any inferences about the efficacy of structured lifestyle modification to augment the response to drug therapy. Given this genuine equipoise, a critical step in ensuring that our treatment of patients with obesity is robustly evidence-based is to determine whether "drug plus lifestyle" offer any advantage over "drug plus placebo" in large, well-designed and adequately powered clinical trials. We also need to determine the cost-effectiveness of these programmes.

The Role of Social License in Non-Industrial Marine and Coastal Planning: a Scoping Review.

Marine and coastal environments are diverse and dynamic, supporting competing human interests and demands. As society seeks to balance contested uses of space, more holistic planning processes have emerged, which consider social, economic, and ecological factors. One approach that considers social factors, and more specifically social acceptance, is "social license to operate" (SLO). Originating in the terrestrial mining industry, SLO has been adopted by various marine industries. Except for some emerging work in the conservation field, SLO is typically applied to industrial marine and coastal contexts. To understand SLO's uses in other marine and coastal planning contexts, namely conservation, adaptation, and restoration, we conducted a scoping review using the term SLO and similar concepts, including public or social acceptance, support, and buy-in. Results indicate the concept of SLO is still emerging in non-industrial marine and coastal planning, with an emphasis on gaining public acceptance rather than maintaining it. The concept of SLO was applied broadly, including as a measurement for public support and a product of effective engagement. Most publications focused on barriers and drivers of SLO. Influential factors are identified and organized by theme, then discussed based on their relationships within a social-ecological system framework. Considering the common factors and their associated systems helps to link elements necessary to obtain SLO, highlighting their interconnectedness with each other, society, and the natural environment. The findings of this review illustrate SLO's utility for academics and practitioners alike, through its application in methods, tools, values, and concepts that characterize public inclusion for marine and coastal planning.

Road traffic noise and cognitive function in older adults: a cross-sectional investigation of The Irish Longitudinal Study on Ageing.

BACKGROUND: The World Health Organization published updated Environmental Noise Guidelines in 2018. Included are recommended limit values for environmental noise exposure based on systematic reviews for a range of health outcomes, including cognitive impairment. There is emerging evidence in the literature that chronic exposure to road traffic noise may affect cognitive function in older adults, but this relationship is not well established. This study spatially linked nationally representative health microdata from The Irish Longitudinal Study on Ageing to building-level modelled noise data for two cities in the Republic of Ireland. This was used to investigate associations between exposure to road traffic noise and cognitive function in a sample of older adults, independent of a range of socio-demographic and behavioural characteristics, as well as exposure to air pollution. METHODS: We used the Predictor-LimA Advanced V2019.02 software package to estimate noise originating from road traffic for the cities of Dublin and Cork in Ireland according to the new common noise assessment methodology for the European Union (CNOSSOS-EU). Noise exposure values were calculated for each building and spatially linked with geo-coded TILDA microdata for 1706 individuals aged 54 and over in the two cities. Ordinary least squares linear regression models were estimated for eight standardised cognitive tests including noise exposure as an independent variable, with standard errors clustered at the household level. Models were adjusted for individual sociodemographic, behavioural and environmental characteristics. RESULTS: We find some evidence that road traffic noise exposure is negatively associated with executive function, as measured by the Animal Naming Test, among our sample of older adults. This association appears to be accounted for by exposure to air pollution when focusing on a sub-sample. We do not find evidence of an association between noise exposure and memory or processing speed. CONCLUSIONS: Long term exposure to road traffic noise may be negatively associated with executive function among older adults.

Addressing uncertainty about the role of structured lifestyle modification for metabolic surgery patients.

There is good evidence that structured lifestyle modification programmes improve health in patients with metabolic and cardiovascular disorders, but there is no specific evidence that they improve outcomes in patients undergoing metabolic or obesity surgery. Despite expert consensus guidelines stating this fact, some healthcare systems still compel patients to participate in a structured lifestyle modification programme prior to metabolic or obesity surgery. There is a well-established need for individualised multidisciplinary dietetic and physical activity care for metabolic and obesity surgery patients, and the benefits of intentional weight loss prior to surgery are well proven, but these are distinct from potentially harmful requirements for patients to undertake compulsory structured lifestyle programmes of fixed duration, frequency and intensity, which may delay surgery and reinforce obesity stigma. A critical step in rejuvenating metabolic surgery is to reframe patient participation in structured lifestyle modification programmes as an opportunity for education and empowerment, not as an indicator of motivation or suitability for metabolic surgery. Large, well-designed and adequately powered clinical trials are needed to address uncertainties in the evidence base for these programmes. Given genuine equipoise, they will need to determine whether "surgery plus lifestyle" is superior to "surgery plus placebo". Moreover, they will need to determine the cost-effectiveness of these programmes and identify some of the factors giving rise to the substantial heterogeneity in responses to structured lifestyle modification.

Nation-based peer assessment of Europe's Sustainable Development Goal performance.

Less than seven years remain for Europe to meet the targets of the United Nations Sustainable Development Goals (SDGs). However robust and accurate methods for assessing SDG progress are currently lacking. Through the development of several SDG indices, this study addresses this critical knowledge gap by providing the means to accurately identify national 'problem areas' and thereby accelerate SDG achievement. Specifically, an indicator-based approach has been used to create a composite index containing 166 unique SDG indicators that assess a nation's SDG performance compared to the best and worst performers in the European Union (EU). Our results indicate that each EU nation is on average, 58% of the way towards the best performer in the overall SDG indicator framework. A nuanced taxonomy has been developed that allows for the assessment of SDG performance in several critical dimensions of the SDGs, including in 'Means-of-Implementation (MoI)', 'Linkage', and 'Outcome' indicators. The index's comprehensive framework allows for EU's performance in individual SDG indicators to be investigated while providing the most accurate assessment of national SDG performance, to date. Overall, the indices presented in this paper can significantly enhance the understanding of SDG performance while concurrently guiding national and EU SDG policy development.

Factors associated with weight loss and health gains in a structured lifestyle modification programme for adults with severe obesity: a prospective cohort study.

Background: Individual responses to behavioural weight loss interventions can vary significantly, and a better understanding of the factors associated with successful treatment might help to target interventions for those who will benefit the most. We sought to identify demographic and clinical characteristics that predicted intervention "success" (defined as ≥5% weight loss) and other health gains in patients with severe obesity attending a ten-week structured lifestyle modification programme. Methods: We conducted a prospective cohort study of all 1122 patients (751 (66.9%) female, mean age 47.3 ± 11.9 years, mean body mass index (BMI) 46.7 ± 7.8 kgm-2) referred from our hospital-based obesity clinic, who started the structured lifestyle programme between 2012-2019. We compared routine clinical measures such as weight, fitness, blood pressure, lipids and HbA1c at baseline and follow-up. We also used validated questionnaires to quantify anxiety, depression and health-related quality of life. Results: Of 1122 patients who started, 877 (78.2%) completed the programme and attended for follow up. Of these, 12.8% lost ≥5% body weight. The amount of weight lost was a strong and consistent predictor of improvements in metabolic, cardiovascular, and mental health, even after adjusting for age, sex, programme attendance and baseline fitness. Older age, male sex, being physically active and having lower anxiety and depression scores at baseline predicted greater weight loss. Younger age, depression and longer wait time to start the intervention were associated with drop-out. Conclusions: In adults with severe obesity completing a structured lifestyle modification programme, older age and good mental health were associated with programme completion and attaining ≥5% weight loss. The magnitude of weight lost was a strong predictor of improvements in cardiovascular, metabolic and mental health associated with programme completion.

Adipose tissue is a source of regenerative cells that augment the repair of skeletal muscle after injury.

Fibro-adipogenic progenitors (FAPs) play a crucial role in skeletal muscle regeneration, as they generate a favorable niche that allows satellite cells to perform efficient muscle regeneration. After muscle injury, FAP content increases rapidly within the injured muscle, the origin of which has been attributed to their proliferation within the muscle itself. However, recent single-cell RNAseq approaches have revealed phenotype and functional heterogeneity in FAPs, raising the question of how this differentiation of regenerative subtypes occurs. Here we report that FAP-like cells residing in subcutaneous adipose tissue (ScAT), the adipose stromal cells (ASCs), are rapidly released from ScAT in response to muscle injury. Additionally, we find that released ASCs infiltrate the damaged muscle, via a platelet-dependent mechanism and thus contribute to the FAP heterogeneity. Moreover, we show that either blocking ASCs infiltration or removing ASCs tissue source impair muscle regeneration. Collectively, our data reveal that ScAT is an unsuspected physiological reservoir of regenerative cells that support skeletal muscle regeneration, underlining a beneficial relationship between muscle and fat.

Estimating the harmful effects of environmental transport noise: An EU study.

Annex III of the Environmental Noise Directive (END), referring to the provision of dose-effect relations for the assessment of harmful effects caused by environmental noise, has been recently amended with the ratification of Commission Directive (EU) 2020/367. It describes how harmful effects from environmental noise may be calculated for ischemic heart disease (IHD), high annoyance (HA), and high sleep disturbance (HSD) for road, rail, and aircraft noise for EU Member States (MS). Within this context, this analysis utilises the calculation procedures outlined in the Directive to undertake a case study of the quantification of environmental noise-induced harmful effects in Ireland. The study generates acoustic models for road traffic and railway noise using the new CNOSSOS-EU method instead of using national data submitted under the END and, to our knowledge, is the first EU study to do so. In the case of Ireland, the results indicate that 256 noise-induced IHD, 296,471 HA, and 109,951 HSD cases are attributable to transport (road, rail, aircraft) noise in Ireland. The results outline the scale of harmful effects from environmental noise from transport in Ireland and are instructive for other EU members states in terms of the approach utilised.

A numerical framework for modeling fate and transport of microplastics in inland and coastal waters.

Proliferation of microplastics in rivers, lakes, estuaries, coastal waters and oceans is a major global challenge and threat to the environment, livelihoods and human health. Reliable predictive tools can play an essential role in developing an improved understanding of microplastics behaviour, exposure and risk in water bodies, and facilitate identification of sources and accumulation hot spots, thereby enabling informed decision-making for targeted prevention and clean-up activities. This study presents a new numerical framework (CaMPSim-3D) for predicting microplastics fate and transport in different aquatic settings, which consists of a Lagrangian, three-dimensional (3D) particle-tracking model (PTM) coupled with an Eulerian-based hydrodynamic modeling system (TELEMAC). The 3D PTM has several innovative features that enable accurate simulation and efficient coupling with TELEMAC, which utilizes an unstructured computational mesh. The PTM is capable of considering spatio-temporally varying diffusivity, and uses an innovative algorithm to locate particles within the Eulerian mesh. Model accuracy associated with different advection schemes was verified by comparing numerical predictions to known analytical solutions for several test cases. The implications of choosing different advection schemes for modeling microplastics transport was then investigated by applying the PTM to simulate particle transport in the lower Saint John River Estuary in eastern Canada. The sensitivity of the PTM predictions to the advection scheme was investigated using six numerical schemes with different levels of complexity. Predicted particle distributions and residence times based on the fourth-order Runge-Kutta (RK4) scheme differed significantly (residence times by up to 100 %) from those computed using the traditional first-order (Euler) method. The Third Order Total Variation Diminishing (TVD3) Runge-Kutta method was found to be optimal, providing the closest results to RK4 with approximately 27 % lower computational cost.

Fate and transport of coastal driftwood: A critical review.

Driftwood originating from natural and anthropogenic sources is abundant in coastal regions and plays an important role in ecosystems, providing habitat, structure, nutrients, and carbon storage. Conversely, large accumulations of driftwood can litter coastal zones, negatively impact coastal ecosystems and pose hazards to navigation, infrastructure and communities. Knowledge of the processes underlying the fate and transport of coastal driftwood is therefore needed to inform sustainable management practices. The present state of understanding is limited, and predominantly founded on studies of rivers and tsunamis, where the spatio-temporal scales and driving processes are significantly different from typical climatic or storm conditions in coastal waters. The authors critically review research on fate and transport of driftwood in coastal waters, and identify research needs and opportunities. Key knowledge gaps relate to: interactions between driftwood, littoral zone hydrodynamics and geomorphology; mechanisms of driftwood rafting and accumulation; and influence of weathering and degradation on mobility.

Assessing the Treatment of Potential Effect Modifiers Informing World Health Organisation Guidelines for Environmental Noise.

Methodologies employed in the production of systematic reviews used to inform policy must be robust. In formulating the recent World Health Organisation (WHO) Environmental Noise Guidelines for the European Region, seven systematic reviews of evidence were commissioned to assess the relationship between environmental noise exposure and a range of health outcomes, six of which were nonauditory. Within the methodological guidance document devised for these reviews, inclusion and exclusion criteria for individual studies and existing reviews were applied in accordance with the Population-Exposure-Comparator-Outcome-Study (PECOS) framework for the evaluation of evidence. Specific criteria were defined for "populations" and source-specific "exposure", but no criteria were defined for the treatment of potential "effect modifiers". Furthermore, no criteria were set for the treatment of combined exposures. Employing a custom-designed assessment matrix, we assess the treatment of potential effect modifiers in the formulation of the aforementioned systematic reviews, all published in a Special Issue of the International Journal of Environmental Research and Public Health (IJERPH), titled "WHO Noise and Health Evidence Reviews". We identify substantial methodological variation in their treatment and propose the differentiation of "moderators" and "mediators" from "confounders" as the basis for criteria development-including combined exposures-for future systematic reviews.

Growth and differentiation factor 15 is secreted by skeletal muscle during exercise and promotes lipolysis in humans.

We hypothesized that skeletal muscle contraction produces a cellular stress signal, triggering adipose tissue lipolysis to sustain fuel availability during exercise. The present study aimed at identifying exercise-regulated myokines, also known as exerkines, able to promote lipolysis. Human primary myotubes from lean healthy volunteers were submitted to electrical pulse stimulation (EPS) to mimic either acute intense or chronic moderate exercise. Conditioned media (CM) experiments with human adipocytes were performed. CM and human plasma samples were analyzed using unbiased proteomic screening and/or ELISA. Real-time qPCR was performed in cultured myotubes and muscle biopsy samples. CM from both acute intense and chronic moderate exercise increased basal lipolysis in human adipocytes. Growth and differentiation factor 15 (GDF15) gene expression and secretion increased rapidly upon skeletal muscle contraction. GDF15 protein was upregulated in CM from both acute and chronic exercise-stimulated myotubes. We further showed that physiological concentrations of recombinant GDF15 protein increased lipolysis in human adipose tissue, while blocking GDF15 with a neutralizing antibody abrogated EPS CM-mediated lipolysis. We herein provide the first evidence to our knowledge that GDF15 is a potentially novel exerkine produced by skeletal muscle contraction and able to target human adipose tissue to promote lipolysis.

Phenotypic Responses to a Lifestyle Intervention Do Not Account for Inter-Individual Variability in Glucose Tolerance for Individuals at High Risk of Type 2 Diabetes.

Background: Lifestyle interventions have been shown to delay or prevent the onset of type 2 diabetes among high risk adults. A better understanding of the variability in physiological responses would support the matching of individuals with the best type of intervention in future prevention programmes, in order to optimize risk reduction. The purpose of this study was to determine if phenotypic characteristics at baseline or following a 12 weeks lifestyle intervention could explain the inter-individual variability in change in glucose tolerance in individuals with high risk for type 2 diabetes. Methods: In total, 285 subjects with normal glucose tolerance (NGT, FINDRISC score > 12), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) were recruited for a 12 weeks lifestyle intervention. Glucose tolerance, insulin sensitivity, anthropometric characteristics and aerobic fitness were measured. Variability of responses was examined by grouping participants by baseline glycemic status, by cluster analysis based on the change in glucose tolerance and by Principal Component Analysis (PCA). Results: In agreement with other studies, the mean response to the 12 weeks intervention was positive for the majority of parameters. Overall, 89% improved BMI, 80% waist circumference, and 81% body fat while only 64% improved fasting plasma glucose and 60% 2 h glucose. The impact of the intervention by glycaemic group did not show any phenotypic differences in response between NGT, IFG, and IGT. A hierarchical cluster analysis of change in glucose tolerance identified four sub-groups of "responders" (high and moderate) and "non-responders" (no response or deteriorated) but there were few differences in baseline clincal and physiological parameters or in response to the intervention to explain the overall variance. A further PCA analysis of 19 clinical and physiological univariables could explain less than half (48%) of total variability. Conclusion: We found that phenotypic characteristics from standard clinical and physiological parameters were not sufficient to account for the inter-individual variability in glucose tolerance following a 12 weeks lifestyle intervention in inidivuals at high risk for type 2 diabetes. Further work is required to identify biomarkers that complement phenotypic traits and better predict the response to glucose tolerance.

Energy expenditure and affect responses to different types of active video game and exercise.

BACKGROUND: The purpose of this study was to compare entertainment-themed active video game (AVG) and fitness-themed AVG play with traditional exercise to examine the interaction between physiological and psychological responses. METHODS: Participants (N = 23) were randomly assigned to 30-min of (i) self-selected intensity exercise (SS-EX), (ii) moderate intensity exercise (MOD-EX), (iii) entertainment-themed video game (ET-VG) and (iv) fitness-themed video game (FT-VG). Physiological and psychological outcomes were recorded before, during and after each trial. RESULTS: All trials met the ACSM criteria for moderate or vigorous physical activity. The [Formula: see text] (68.3±13.9%) and rate of energy expenditure (10.3±3.1kcal/min) was significantly higher in the SS-EX trial with lowest values reported for ET-VG (p<0.05). No differences were found in % heart rate reserve between SS-EX and FT-VG (66.9±12.5% and 67.1±6% respectively). The AVG's were significantly more enjoyable than the exercise trials (p<0.05) and the ET-VG resulted in the highest core flow and psychological well-being (p<0.05). CONCLUSION: AVG's can elicit physiological responses that meet recommended exercise intensities but are more enjoyable than conventional exercise in young inactive adults. While further work is required, this study highlights the importance of examining the interaction between physiological outcomes and psychological states to increase physical activity and reduce sedentary time.

Smartphone-based noise mapping: Integrating sound level meter app data into the strategic noise mapping process.

The strategic noise mapping process of the EU has now been ongoing for more than ten years. However, despite the fact that a significant volume of research has been conducted on the process and related issues there has been little change or innovation in how relevant authorities and policymakers are conducting the process since its inception. This paper reports on research undertaken to assess the possibility for smartphone-based noise mapping data to be integrated into the traditional strategic noise mapping process. We compare maps generated using the traditional approach with those generated using smartphone-based measurement data. The advantage of the latter approach is that it has the potential to remove the need for exhaustive input data into the source calculation model for noise prediction. In addition, the study also tests the accuracy of smartphone-based measurements against simultaneous measurements taken using traditional sound level meters in the field.

An assessment of residential exposure to environmental noise at a shipping port.

The World Health Organisation has recently acknowledged that contrary to the trend for other environmental stressors, noise exposure is increasing in Europe. However, little research has been conducted on environmental noise exposure to handling activity at shipping ports. This paper reports on research examining the extent of noise exposure for residents within the vicinity of Dublin Port, Ireland using the nation's largest port terminal as a proxy for port noise. In order to assess the level of exposure in the area, long-term measurements were undertaken at the most exposed residential façade for a period of 45days to determine the extent of night-time exposure that was above levels recommended by the World Health Organisation. The indicators L90, Leq and LMax were used to determine exposure levels. The results show that exposure is above night-time guideline limits set down by the WHO, above Irish levels for the assessment of noise mitigation and highlight the extent to which port noise can be a significant environmental stressor. The research also investigated the extent of low-frequency noise (which is associated with greater health issues) from night-time port handling activity and found a significant low-frequency component indicating the negative health issues that might arise from port noise exposure more generally. We also undertook semi-structured interviews with residents to qualitatively assess the self-reported impact of prolonged night-time noise exposure for local residents.

Impact of enhanced geothermal systems on US energy supply in the twenty-first century.

Recent national focus on the value of increasing US supplies of indigenous renewable energy underscores the need for re-evaluating all alternatives, particularly those that are large and well distributed nationally. A panel was assembled in September 2005 to evaluate the technical and economic feasibility of geothermal becoming a major supplier of primary energy for US base-load generation capacity by 2050. Primary energy produced from both conventional hydrothermal and enhanced (or engineered) geothermal systems (EGS) was considered on a national scale. This paper summarizes the work of the panel which appears in complete form in a 2006 MIT report, 'The future of geothermal energy' parts 1 and 2. In the analysis, a comprehensive national assessment of US geothermal resources, evaluation of drilling and reservoir technologies and economic modelling was carried out. The methodologies employed to estimate geologic heat flow for a range of geothermal resources were utilized to provide detailed quantitative projections of the EGS resource base for the USA. Thirty years of field testing worldwide was evaluated to identify the remaining technology needs with respect to drilling and completing wells, stimulating EGS reservoirs and converting geothermal heat to electricity in surface power and energy recovery systems. Economic modelling was used to develop long-term projections of EGS in the USA for supplying electricity and thermal energy. Sensitivities to capital costs for drilling, stimulation and power plant construction, and financial factors, learning curve estimates, and uncertainties and risks were considered.