Adopting a systems-thinking approach to optimise dietary and exercise referral practices for cancer survivors.

PURPOSE: Service referrals are required for cancer survivors to access specialist dietary and exercise support. Many system-level factors influence referral practices within the healthcare system. Hence, the aim of this study was to identify system-level factors and their interconnectedness, as well as strategies for optimising dietary and exercise referral practices in Australia. METHODS: A full-day workshop involving national multidisciplinary key stakeholders explored system-level factors impacting dietary and exercise referral practices. Facilitated group discussions using the nominal group technique identified barriers and facilitators to referral practices based on the six World Health Organisation (WHO) building blocks. The systems-thinking approach generated six cognitive maps, each representing a building block. A causal loop diagram was developed to visualise factors that influence referral practices. Additionally, each group identified their top five strategies by leveraging facilitators and addressing barriers relevant to their WHO building block. RESULTS: Twenty-seven stakeholders participated in the workshop, including consumers (n = 2), cancer specialists (n = 4), nursing (n = 6) and allied health professionals (n = 10), and researchers, representatives of peak bodies, not-for-profit organisations, and government agencies (n = 5). Common system-level factors impacting on referral practices included funding, accessibility, knowledge and education, workforce capacity, and infrastructure. Fifteen system-level strategies were identified to improve referral practices. CONCLUSION: This study identified system-level factors and strategies that can be applied to policy planning and practice in Australia.

Hot water immersion acutely reduces peripheral glucose uptake in young healthy males: An exploratory crossover randomized controlled trial.

Whether glucose concentration increases during heat exposure because of reduced peripheral tissue uptake or enhanced appearance is currently unknown. This study aimed to report glucose concentrations in both capillary and venous blood in response to a glucose challenge during passive heating (PH) to assess whether heat exposure affects glucose uptake in healthy males. Twelve healthy male participants completed two experimental sessions, where they were asked to undertake an oral glucose tolerance test (OGTT) whilst immersed in thermoneutral (CON, 35.9 (0.6) °C) and hot water (HWI, 40.3 (0.5) °C) for 120 min. Venous and capillary blood [glucose], rectal temperature, and heart rate were recorded. [Glucose] area under the curve for HWI venous (907 (104) AU) differed from CON venous (719 (88) AU, all P < 0.001). No other differences were noted (P > 0.05). Compared with CON, HWI resulted in greater rectal temperature (37.1 (0.3) °C versus 38.6 (0.4) °C, respectively) and heart rate (69 (12) bpm versus 108 (11) bpm, respectively) on cessation (P < 0.001). An OGTT results in similar capillary [glucose] during hot and thermoneutral water immersion, whereas venous [glucose] was greater during HWI when compared with CON. This indicates that peripheral tissue glucose uptake is acutely reduced in response to HWI. Abbreviations: AUC: Area under the curve; CON: Thermoneutral immersion trial; HWI: Hot water immersion trial; OGTT: Oral glucose tolerance test; PH: Passive heating; T-msk: Mean skin temperature; Trec: Rectal temperature.

Prevalence and management of sleep disturbance in adults with primary brain tumours and their caregivers: a systematic review.

PURPOSE: The aims of this systematic review were to (1) examine the prevalence, severity, manifestations, and clinical associations/risk factors of sleep disturbance in primary brain tumour (PBT) survivors and their caregivers; and (2) determine whether there are any sleep-focused interventons reported in the literature pertaining to people affected by PBT. METHODS: This systematic review was registered with the international register for systematic reviews (PROSPERO: CRD42022299332). PubMed, EMBASE, Scopus, PsychINFO, and CINAHL were electronically searched for relevant articles reporting sleep disturbance and/or interventions for managing sleep disturbance published between September 2015 and May 2022. The search strategy included terms focusing on sleep disturbance, primary brain tumours, caregivers of PBT survivors, and interventions. Two reviewers conducted the quality appraisal (JBI Critical Appraisal Tools) independently, with results compared upon completion. RESULTS: 34 manuscripts were eligible for inclusion. Sleep disturbance was highly prevalent in PBT survivors with associations between sleep disturbance and some treatments (e.g., surgical resection, radiotherapy, corticosteroid use), as well as other prevalent symptoms (e.g., fatigue, drowsiness, stress, pain). While the current review was unable to find any sleep-targeted interventions, preliminary evidence suggests physical activity may elicit beneficial change on subjectively reported sleep disturbance in PBT survivors. Only one manuscript that discussed caregivers sleep disturbance was identified. CONCLUSIONS: Sleep disturbance is a prevalent symptom experienced by PBT survivors, yet there is a distinct lack of sleep-focused interventions in this population. This includes a need for future research to include caregivers, with only one study identified. Future research exploring interventions directly focused on the management of sleep disturbance in the context of PBT is warranted.

Essential elements of optimal dietary and exercise referral practices for cancer survivors: expert consensus for medical and nursing health professionals.

PURPOSE: To develop and establish expert consensus on essential elements of optimal dietary and exercise referral practices for cancer survivors. METHODS: A four-round modified, Delphi method (face-to-face and electronic). In round 1, initial statements were drafted based on Cancer Australia's Principles of Cancer Survivorship and input from key stakeholders through a cancer preconference workshop. In round 2, the initial statements were distributed to a panel (round 1 participants) to establish consensus by rating the importance of each statement using a five-point Likert scale. Statements that required significant changes in wording were redistributed to panel members in round 3 for voting. Round 4 was for consumers, requiring them to rate their level of agreement of final statements. RESULTS: In total, 82 stakeholders participated in round 1. Response rates for survey rounds 2 and 3 were 59% (n = 54) and 39% (n = 36). Panel members included nurses (22%), dietitians (19%), exercise professionals (16%), medical practitioners (8%), and consumers (4%). The mean "importance" rating for all essential elements was 4.28 or higher (i.e., fairly important, or very important). Round 4's consumer-only engagement received responses from 58 consumers. Overall, 24 elements reached consensus following some revised wording, including the development of three new statements based on panel feedback. CONCLUSION: Our developed essential elements of optimal dietary and exercise referral practices can help provide guidance to medical and nursing health professionals relevant to dietary and exercise referral practices. Future research should conduct an implementation intervention and evaluation of these essential elements to optimise dietary and exercise care in cancer survivors.

Daily Fluid Intake Behaviors and Associated Health Effects Among Australian and United States Populations.

Minimal data exist exploring intercontinental differences in fluid intake (FI) beliefs and behaviors and the impact on fluid intake practices (i.e., fluid intake volume, beverage type, and timing of fluid intake). Therefore, this study explored the impact that FI beliefs and behaviors had on FI practices among emerging adults living in the United States (USA) and Australia (AUS). A total of 489 individuals (74.5% female; USA, 79.4%; age, 25 ± 6 years completed a 23-item survey between November 2020 and June 2021). Participants detailed their FI practices. FI beliefs were evaluated to determine their contribution to FI behaviors across the day. Multinomial and multiple linear regression analyses explored the association of daily FI beliefs and behaviors across multiple domains. Independent sample t-tests and chi-square analyses were conducted to compare FI practices, beliefs, and behaviors between individuals in the USA and AUS. FI behaviors were significantly different between countries, with the USA more likely to consume fluids to meet a total target volume (ß = 1.150, p = 0.036) and consume fluid at the same time as structured daily activities (ß = 0.773, p = 0.046) compared to FI alongside food intake. However, there were no differences in the types of beverage consumed (juice, sugar-sweetened beverages, tea, and coffee), total fluid volume, and physical activity (PA) between countries (p > 0.05). Beverage consumption was higher among USA than AUS residents for water, beer, and wine (p < 0.05). Total fluid consumption was greater among males (3,189 ± 2,407 ml) than females (2,215 ± 1,132 ml; ß = 3.61, p < 0.001), individuals who regularly consumed fluid during the day to meet a targeted volume (ß = 1,728.5, p < 0.001), and those who regularly consumed fluid as a habitual behavior (ß = 3.97, p < 0.001) compared to those individuals who only consumed fluid alongside mealtimes (ß = 1,041.7, p < 0.001). FI behaviors differed between the USA and AUS; however, total volume consumed, type of beverage consumed, and FI beliefs were similar. FI practices and behaviors appear to be individualized and context-specific among the studied populations.

Development and approval of rybelsus (oral semaglutide): ushering in a new era in peptide delivery.

Achieving efficacious systemic levels of orally administered peptides is incredibly challenging due to the significant barriers to their bioavailability-their stability in the gastrointestinal tract and challenge of transepithelial transit, and variable pharmacokinetics. Even so, as the generally preferred route of administration, significant research effort in academic and industrial settings has focused on enabling the systemic absorption of orally delivered peptides. Despite several decades of research, few have ever reached the market. The recent approval of Rybelsus® (oral semaglutide) by the FDA [1], the EMA [2], and the Pmda [3] represents a significant landmark in the delivery of therapeutic peptides and is the culmination of more than 30 years research and development of the drug delivery technology enabling the product-Emisphere's Eligen™ technology-and an outstanding commitment to scientific, technical, and clinical innovation by Novo Nordisk. Following years of fundamental and applied research, an innovative clinical strategy led to the aptly named PIONEER clinical programme. This included ten Phase 3 clinical trials that demonstrated the tablet formulation to be as effective as the already approved injectable form of the drug, and more effective than competitor products in terms of its blood glucose lowering effects and weight loss. Not only is this a potentially life changing medicine for diabetic patients, it holds tremendous commercial potential for Novo Nordisk, with some analysts predicting the product to reach $5 billion in peak revenues [3]. In this "Inspirational Note," we summarize some of the public domain work that led to the achievement of this significant milestone and provide commentary on its potential future impact.

Physical functional capacity of patients with glioma prior to adjuvant radiation: preliminary descriptive study.

BACKGROUND: Few studies have assessed physical functioning in glioma patients with grade II, III, and IV glioma prior to undergoing adjuvant radiation with or without chemotherapy. The aim of this study was to describe the baseline physical functioning capacity of patients with glioma prior to adjuvant therapy compared to validated cutoffs required to maintain independence. METHODS: This study is a cross-sectional study that recruited patients with grade II, III, and IV glioma (n = 33) undergoing adjuvant radiation with or without chemotherapy. The six-minute walk, thirty-second sit-to-stand, and timed "Up & Go" assessments were used to describe baseline physical functioning. Perceived quality of life from the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-C30) version 3.0 was used to quantify the quality of life. RESULTS: Mean distance walked in the six-minute walk test was 416.2 m (SD 137.6 m) with a mean of 12.2 stands (SD 3.4 stands) achieved during the thirty-second sit-to-stand. Median time to complete the timed "Up & Go" assessment was 7 s (interquartile range: 3 s). One-sample t tests suggest walking distance and chair stands were significantly lower than cutoff criterions to maintain independent living, t(32) = -5.96, P < .001, bias-corrected accelerated 95% CI [370.7-460.4], and t(32) = -4.60, P < .01, bias-corrected accelerated 95% CI [11.0-13.4], respectively. Wilcoxon signed-rank test identified significantly shorter median time taken to complete the timed "Up & Go" test compared to the cutoff criterion (z = -4.43, n = 33, P < .01). CONCLUSION: This study suggests glioma patient's aerobic endurance and lower limb strength are below criterion cutoffs recommended to maintain independent living. Timed "Up & Go" scores did not exceed the criterion cutoff, indicating respectable levels of mobility.

Core Temperature Responses in Elite Cricket Players during Australian Summer Conditions.

This study aimed to observe core temperature responses in elite cricket players under match conditions during the summer in Australia. Thirty-eight Australian male cricketers ingested capsule temperature sensors during six four-day first-class matches between February 2016 and March 2017. Core temperature (Tc) was recorded during breaks in play. Batters showed an increase in Tc related to time spent batting of approximately 1 °C per two hours of play (p < 0.001). Increases in rate of perceived exertion (RPE) in batters correlated with smaller elevations in Tc (0.2 °C per one unit of elevation in RPE) (p < 0.001). Significant, but clinically trivial, increases in Tc of batters were found related to the day of play, wet bulb globe temperature (WBGT), air temperature, and humidity. A trivial increase in Tc (p < 0.001) was associated with time in the field and RPE when fielding. There was no association between Tc and WBGT, air temperature, humidity, or day of play in fielders. This study demonstrates that batters have greater rises in Tc than other cricket participants, and may have an increased risk of exertional heat illness, despite exposure to similar environmental conditions.

Tear osmolarity is sensitive to exercise-induced fluid loss but is not associated with common hydration measures in a field setting.

This investigation (i) examined changes in tear osmolarity in response to fluid loss that occurs with exercise in a field setting, and (ii) compared tear osmolarity with common field and laboratory hydration measures.  Sixty-three participants [age 27.8 ± 8.4 years, body mass 72.15 ± 10.61 kg] completed a self-paced 10 km run outside on a predetermined course. Body mass, tear fluid, venous blood and urine samples were collected immediately before and after exercise.  Significant (p < 0.001) reductions in body mass (1.71 ± 0.44%) and increases in tear osmolarity (8 ± 15 mOsm.L-1), plasma osmolality (7 ± 8 mOsm.kg-1), and urine specific gravity (0.0014 ± 0.0042 g.mL-1; p = 0.008) were observed following exercise. Pre- to post-exercise change in tear osmolarity was not significantly correlated (all p > 0.05) with plasma osmolality (rs = 0.24), urine osmolality (rs = 0.14), urine specific gravity (rs = 0.13) or relative body mass loss (r = 0.20).  Tear osmolarity is responsive to exercise-induced fluid loss but does not correlate with the changes observed using other common measures of hydration status in the field setting. Practitioners shouldn't directly compare or replace other common hydration measures with tear osmolarity in the field. ABBREVIATIONS: BML: Body Mass Loss; CV: Coefficient of Variation; Posm: Plasma osmolality; SD: Standard Deviation; Tosm: Tear Osmolarity; Uosm: Urine Osmolality; USG: Urine Specific Gravity; WBGT: Wet bulb globe thermometer.

The Influence of Drinking Fluid on Endurance Cycling Performance: A Meta-Analysis.

BACKGROUND: Fluid replacement during cycling exercise evolves on a spectrum from simply drinking to thirst to planned structured intake, with both being appropriate recommendations. However, with mixed findings suggesting fluid intake may or may not improve endurance cycling performance (ECP) in a diverse range of trained individuals, there is a clear need for summarised evidence regarding the effect of fluid consumption on ECP. OBJECTIVES: (1) Determine the magnitude of the effect of drinking fluid on performance during cycling exercise tasks of various durations, compared with no drinking; (2) examine the relationship between rates of fluid intake and ECP; and (3) establish fluid intake recommendations based on the observations between rates of fluid intake and ECP. STUDY DESIGN: Meta-analysis. METHODS: Studies were located via database searches and cross-referencing. Performance outcomes were converted to a similar metric to represent percentage change in power output. Fixed- and random-effects weighted mean effect summaries and meta-regression analyses were used to identify the impact of drinking fluid on ECP. RESULTS: A limited number of research manuscripts (n = 9) met the inclusion criteria, producing 15 effect estimates. Meta-regression analyses demonstrated that the impact of drinking on ECP under 20-33 °C ambient temperatures was duration-dependent. Fluid consumption of, on average, 0.29 mL/kg body mass/min impaired 1 h high-intensity (80% peak oxygen uptake [[Formula: see text]o2peak]) ECP by -2.5 ± 0.8% (95% confidence interval [CI] -4.1 to -0.9%) compared with no fluid ingestion. In contrast, during >1 to ≤2 h and >2 h moderate-intensity (60-70% [Formula: see text]o2peak) cycling exercise, ECP improved by 2.1 ± 1.5% (95% CI 1.2-2.9%) and 3.2 ± 1.2% (95% CI 0.8-5.6%), respectively, with fluid ingestion compared with no fluid intake. The associated performance benefits were observed when the rates of fluid intake were in the range of 0.15-0.20 mL/kg body mass/min for >1 to ≤2 h cycling exercise and ad libitum or 0.14-0.27 mL/kg body mass/min for cycling exercise >2 h. CONCLUSIONS: A rate of fluid consumption of between 0.15 and 0.34 mL/kg body mass/min during high-intensity 1 h cycling exercise is associated with reductions in ECP. When cycling at moderate intensity for >1 to ≤2 h, cyclists should expect a gain in performance of at least 2% if fluid is consumed at a rate of 0.15-0.20 mL/kg body mass/min. For cycling exercise >2 h conducted at moderate intensity, consuming fluid ad libitum or at a rate of 0.14-0.27 mL/kg body mass/min should improve performance by at least 3%. Until further research is conducted, these recommendations should be used as a guide to inform hydration practices.

Methane production in a 100-L upflow bioreactor by anaerobic digestion of farm waste.

Manure waste from dairy farms has been used for methane production for decades, however, problems such as digester failure are routine. The problem has been investigated in small scale (1-2 L) digesters in the laboratory; however, very little scale-up to intermediate scales are available. We report production of methane in a 100-L digester and the results of an investigation into the effect of partial mixing induced by gas upflow/recirculation in the digester. The digester was operated for a period of about 70 d (with 16-d hydraulic retention time) with and without the mixing induced by gas recirculation through an internal draft tube. The results show a clear effect of mixing on digester operation. Without any mixing, the digester performance deteriorated within 30-50 d, whereas with mixing continuous production of methane was observed. This study demonstrates the importance of mixing and its critical role in design of large scale anaerobic digesters.

Methane production in a 100-L upflow bioreactor by anaerobic digestion of farm waste.

Manure waste from dairy farms has been used for methane production for decades, however, problems such as digester failure are routine. The problem has been investigated in small scale (1-2 L) digesters in the laboratory; however, very little scale-up to intermediate scales are available. We report production of methane in a 100-L digester and the results of an investigation into the effect of partial mixing induced by gas upflow/recirculation in the digester. The digester was operated for a period of about 70 d (with 16-d hydraulic retention time) with and without the mixing induced by gas recirculation through an internal draft tube. The results show a clear effect of mixing on digester operation. Without any mixing, the digester performance deteriorated within 30-50 d, whereas with mixing continuous production of methane was observed. This study demonstrates the importance of mixing and its critical role in design of large scale anaerobic digesters.