The effect of pre-exercise protein intake on substrate metabolism, energy expenditure, and energy intake: a dose-response study.

BACKGROUND: Pre-exercise protein consumption does not seem to influence substrate metabolism during exercise compared to fasted exercise, however it is unclear if the protein dose impacts on this effect. METHODS: In a randomized, double-blinded within-subject design trial, healthy, active males and females (n = 15, 25 ± 5 yrs, O2peak: 47.5 ± 8.8 ml/kg/min) completed 1 h of cycling exercise at 60% peak power output 30 min after having consumed either 0, 20, or 40 g of whey protein. Indirect calorimetry was used to measure substrate oxidation during exercise and baseline and post-exercise resting energy expenditure. Blood samples were taken throughout the trials to measure metabolic responses. Free-living food intake post-trial was collected using food diaries. RESULTS: Fat oxidation rates during exercise did not differ between the three conditions (p = 0.19) with small effect sizes between conditions (Cohen's dz: 0 vs. 20 g = 0.22, 0 vs. 40 g = 0.47, 20 vs. 40 g = 0.27). Serum insulin was higher in the protein groups vs. 0 g (p < 0.05), whereas non-esterified fatty acids were higher in the 0 g compared to 20 and 40 g (p < 0.05). Glucose was significantly lower after 15 min of exercise in 20 and 40 g vs. 0 g (p = 0.01). Resting energy expenditure was elevated post-exercise (p < 0.001), without an interaction for protein dose (p = 0.90). Post-trial free-living energy intake was not different between conditions (p = 0.31), but 24-h energy intake was significantly higher in 40 vs. 0 g (p = 0.04). CONCLUSION: Protein doses up to 40 g do not seem to impair fat oxidation rates during exercise compared to fasted exercise and could be considered as a nutritional strategy for exercising individuals who struggle to include fasted exercise in their training.

Financing adaptation for resilient livelihoods under food system transformation: the role of Multilateral Development Banks.

Climate change is imposing a transformative process on agricultural and food systems, threatening the livelihoods of people dependent upon them which includes a large share of the world's poor people. Transformative adaptation that addresses the risks and vulnerabilities to livelihoods that climate change imposes is essential for effective and inclusive transformation of food systems. Financing that is adequate, accessible and appropriate is essential to realizing these objectives. Multilateral Development Banks (MDBs) are already playing an important role in financing transformative adaptation in the agri-food sector and are well-placed to address some of the existing shortcomings. Expanding public sector climate finance and incentivizing private sector investments is needed to attain adequate levels of financing. Reconsidering the rules and procedures for obtaining public sector finance and the capacity to utilize already existent administrative structures, as well as better targeting of activities and communities is important for accessibility. Appropriate finance requires use of mechanisms that address characteristics of the investment, including riskiness, delayed returns, high social values and new and unproven activities. Utilizing blended finance integrated with development finance can generate financing appropriate to the investment needs. Some positive shifts in these directions are already being undertaken by MDBs but more is required.

Fibrin tissue adhesive versus nasal packing in endoscopic nasal surgery: a systematic review and meta-analysis.

BACKGROUND: It has been proposed that fibrin tissue adhesive (FTA) can act as an effective alternative to nasal packing in managing the postoperative symptoms of endoscopic nasal surgery. METHODOLOGY: MEDLINE, Embase, Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov were searched for randomised controlled trials comparing FTA with nasal packing in endoscopic nasal surgery. The primary outcome of interest was bleeding; secondary outcomes included pain, nasal obstruction, infection, adhesions and the formation of granulation tissue. All trials underwent a risk of bias assessment, and a meta-analysis was performed using a random effects model. RESULTS: 315 studies were found, of which four were eligible for inclusion (n = 152). Bleeding was reported in all, with the meta-analysis favouring the packing group, although this was not significant. Nasal obstruction and granulation severity were significantly lower in the FTA group, however, no difference was noted for the outcomes of pain, infection or adhesions. CONCLUSION: Our results indicate minor advantages for using FTA over nasal packing. Unfortunately, the included studies show significant heterogeneity and risk of bias. Based on the available evidence, clinicians must balance the higher cost of FTA against the limited advantages for the patient.

Impact of peer support on student mental wellbeing: a systematic review.

This article was migrated. The article was marked as recommended. Objectives: Many universities use peer support programmes to support students. However, there are currently no guidelines on the most effective way of facilitating emotional wellbeing in students. The aim of this paper is to review the evidence for the effectiveness of peer support to improve mental health wellbeing in university students. Methods: Six electronic databases (Medline, Embase, British Education Index (BEI), Australian Education Index (AEI), PsychINFO and Applied Social Sciences Index and Abstracts (ASSIA)) were searched in December 2017. Search terms included "peer support", "university students" and "mental wellbeing". Studies that did not include peer support or assess the impact of students' mental health were excluded. Data about design and delivery of the peer support intervention and changes in student mental wellbeing outcomes were extracted. Results: 489 records were identified. Three studies met the inclusion criteria; two cross-sectional surveys and one non-randomised intervention study. One study found social support to be the most important protective factor for mental wellbeing. Two studies showed no statistically significant improvement in wellbeing outcomes with peer support. One study found that majority of mentors and mentees found peer support useful. Conclusions: There is currently no evidence that peer support improves mental wellbeing among university students.

Transportation and aging: a research agenda for advancing safe mobility.

PURPOSE: We review what we currently know about older driver safety and mobility, and we highlight important research needs in a number of key areas that hold promise for achieving the safety and mobility goals for the aging baby boomers and future generations of older drivers. DESIGN AND METHODS: Through the use of a framework for transportation and safe mobility, we describe key areas of screening and assessment, remediation and rehabilitation, vehicle design and modification, technological advancements, roadway design, transitioning to nondriving, and alternative transportation to meet the goals of crash prevention and mobility maintenance for older adults. RESULTS: Four cross-cutting themes emerged from this review: safe transportation for older adults is important; older adults have a variety of needs, abilities, and resources; research to help meet the transportation needs of older adults may be of benefit to persons with disabilities; and transportation issues concerning older adults are multifaceted. IMPLICATIONS: Safe mobility is essential to continued engagement in civic, social, and community life, and to the human interactions necessary for health, well-being, and quality of life. When safe driving is no longer possible for older adults, safe and practicable alternative transportation must be available. Furthermore, older adults are individuals; they have specific needs, abilities, and resources. Not all older adults will have difficulty meeting their transportation needs and no single transportation solution will work for all people. Research and countermeasures intended to help meet the transportation needs of older adults will likely also benefit younger users of the transportation system, particularly those with disabilities. The issues surrounding the maintenance of safe transportation for older adults will require an interdisciplinary research approach if we are to make significant progress in the next decade as the baby boomers begin to reach age 70.