Instantaneous Q10 of night-time leaf respiratory CO2 efflux - measurement and analytical protocol considerations.

The temperature sensitivity (e.g. Q10) of night-time leaf respiratory CO2 efflux (RCO2) is a fundamental aspect of leaf physiology. The Q10 typically exhibits a dependence on measurement temperature, and it is speculated that this is due to temperature-dependent shifts in the relative control of leaf RCO2. Two decades ago, a review hypothesized that this mechanistically caused change in values of Q10 is predictable across plant taxa and biomes. Here, we discuss the most appropriate measuring protocol among existing data and for future data collection, to form the foundation of a future mechanistic understanding of Q10 of leaf RCO2 at different temperature ranges. We do this primarily via a review of existing literature on Q10 of night-time RCO2 and only supplement this to a lesser degree with our own original data. Based on mechanistic considerations, we encourage that instantaneous Q10 of leaf RCO2 to represent night-time should be measured: only at night-time; only in response to short-term narrow temperature variation (e.g. max. 10°C) to represent a given midpoint temperature at a time; in response to as many temperatures as possible within the chosen temperature range; and on still attached leaves.

Optimal stomatal theory predicts CO2 responses of stomatal conductance in both gymnosperm and angiosperm trees.

Optimal stomatal theory predicts that stomata operate to maximise photosynthesis (Anet ) and minimise transpirational water loss to achieve optimal intrinsic water-use efficiency (iWUE). We tested whether this theory can predict stomatal responses to elevated atmospheric CO2 (eCO2 ), and whether it can capture differences in responsiveness among woody plant functional types (PFTs). We conducted a meta-analysis of tree studies of the effect of eCO2 on iWUE and its components Anet and stomatal conductance (gs ). We compared three PFTs, using the unified stomatal optimisation (USO) model to account for confounding effects of leaf-air vapour pressure difference (D). We expected smaller gs , but greater Anet , responses to eCO2 in gymnosperms compared with angiosperm PFTs. We found that iWUE increased in proportion to increasing eCO2 in all PFTs, and that increases in Anet had stronger effects than reductions in gs . The USO model correctly captured stomatal behaviour with eCO2 across most datasets. The chief difference among PFTs was a lower stomatal slope parameter (g1 ) for the gymnosperm, compared with angiosperm, species. Land surface models can use the USO model to describe stomatal behaviour under changing atmospheric CO2 conditions.

Blood flow restriction exercise to attenuate postoperative loss of function after total knee replacement: a randomized pilot study.

Aging well is directly associated with a healthy lifestyle. The focus of this paper is to relate that attenuation of postoperative loss of muscle function after a total knee arthroplasty (TKA) is an important consideration. Because patients usually do not tolerate standard high-resistance exercise in the preoperative or postoperative period, they often experience a decline in strength and function. Therefore, we tested the feasibility and acceptability of an alternative low-resistance exercise protocol with blood flow restriction (BFR) using a tourniquet in the preoperative period for patients awaiting TKA. We recruited patients undergoing a TKA and randomized six to the BFR exercise for 4 weeks prior to surgery and four to standard of care (no exercise). We measured physical function using the Short Physical Performance Battery (SPPB), the 6-Minute Walk Test (6MWT), leg strength (peak torque), and pain (numerical pain score) 4 to 5 weeks preoperatively and 2 weeks postoperatively. The clinical management, e.g., anesthetic management, did not differ between groups. No complications were observed. Our findings demonstrate the feasibility and acceptability of the BFR intervention. Although preliminary and not powered for comparison, the BFR group demonstrated less decline in SPPB following surgery (-2.2, 95%CI:-4.4,0.1) compared to the no exercise group (-4.8, 95%CI:-7.8,-1.7). No differences were noted for the 6MWT, leg strength, and pain measurements. We conclude that preoperative low-resistance exercise using the BFR is feasible and acceptable, and this test warrants investigation as an intervention to potentially attenuate the postoperative loss of physical function after TKA.

The impact of sarcopenia and acute muscle mass loss on long-term outcomes in critically ill patients with intra-abdominal sepsis.

BACKGROUND: Sarcopenia is a known risk factor for poor outcomes across many chronic diseases. The impact on outcomes of both pre-existing sarcopenia and acute muscle wasting (AMW) in acute critical illness caused by sepsis remain unclear. METHODS: We conducted a prospective longitudinal cohort study of critically ill patients with intra-abdominal sepsis utilizing abdominal computed tomography at sepsis onset to determine baseline skeletal muscle index (SMI). Biomarkers of inflammation and catabolism were measured through 28 days while hospitalized. We performed follow-up evaluations of strength and physical function at 3, 6, and 12 months, with interval CT analyses at 3 and 12 months to evaluate changes in muscle mass. Measured clinical outcomes included development of chronic critical illness (≥14 days in intensive care with persistent organ dysfunction), long-term functional status, and 1 year mortality. RESULTS: Among 47 sepsis patients enrolled (mean age 53 ± 14 years), half (n = 23; 49%) were sarcopenic at baseline. Overall, sepsis patients exhibited acute and persistent muscle wasting with an average 8% decrease in SMI from baseline at 3 months (P = 0.0008). Sarcopenic (SAR) and non-sarcopenic (NSAR) groups were similar in regards to age and comorbidity burden. SAR patients had greater acute physiologic derangement (APACHE II, 18 vs. 12.5), higher incidence of multiple organ failure (57% vs. 17%), longer hospital (21 vs. 12 days) and intensive care unit length of stays (13 vs. 4 days), and higher inpatient mortality (17% vs. 0%; all P < 0.05). Pre-existing SAR was a strong independent predictor of early death or developing chronic critical illness (odds ratio 11.87, 95% confidence interval CI 1.88-74.9; P = 0.009, area under the curve 0.880) and was associated with significantly higher risk of 1-year mortality (34.9% vs. 4.2%, p = 0.007). Lower baseline SMI was also predictive of poor functional status at 12 months (OR 0.89, 95% confidence interval 0.80-0.99; p = 0.039, area under the curve 0.867). Additionally, SAR patients had AMW with persistent muscle mass loss at 3 months that was associated with decreased health-related quality of life and SF-36 physical function domains (P < 0.05). Persistent AMW at 3 months was not predictive of mortality or poor functional status, with return to near-baseline muscle mass among sepsis survivors by 6 months. CONCLUSIONS: Critically ill patients have an acute and persistent loss of muscle mass after intra-abdominal sepsis, which is associated with decreased health-related quality of life and physical function at 3 months. However, pre-existing sarcopenia, rather than persistent acute muscle mass loss at 3 months after sepsis, is independently associated with poor long-term functional status and increased 1 year mortality.

Assessing the feasibility of using the short physical performance battery to measure function in the immediate postoperative period after total knee replacement.

Measurements of physical function after total knee arthroplasty (TKA) are uncertain and require investments for special equipment, space, and staff. Therefore, we evaluated the Short Physical Performance Battery (SPPB) 4 to 6 weeks preoperatively and 2 weeks following TKA as this test battery addresses lower extremity strength, coordination, and balance, without additional special investments. For context, we also employed the Six-Minute Walk test (6MWT) and peak torque knee extension. Our analysis consisted of three women and one man, with average ages of 68.3±3.9 years. Patients showed a decrease in all functional measurements: SPPB (mean change: -4.8±1.9, 44% decrease), 6MWT (-0.37±.21 m/s, 34% decrease), and peak torque (-11.8±8.8°/s, 68% decrease). Our findings suggest the SPPB is feasible and can be integrated easily in daily clinical practice.

Wearable Technology To Reduce Sedentary Behavior And CVD Risk In Older Adults: A Pilot Randomized Clinical Trial.

BACKGROUND: Physical exercise is associated with decreased cardiovascular disease (CVD) risk, but recent large-scale trials suggest that exercise alone is insufficient to reduce CVD events in high-risk older adults. PURPOSE: This pilot randomized clinical trial aimed to collect critical data on feasibility, safety, and protocol integrity necessary to design a fully powered randomized controlled trial (RCT) and evaluate the impact of combining structured exercise with an intervention designed to enhance non-exercise physical activity (EX+NEPA) compared to EX alone. METHODS: Forty participants aged ≥60 years with moderate-to-high risk of coronary heart disease events were randomly assigned to either the EX+NEPA or EX groups and followed for 20 weeks. Both groups underwent a twice-weekly, 8-week center-based exercise intervention with aerobic and resistance exercises. EX+NEPA group also received a wearable activity tracking device along with behavioral monitoring and feedback throughout the study. Study outcomes were evaluated at 8 and 20 weeks. RESULTS: Data are presented as adjusted mean change of the differences over time with 95% confidence intervals at 20 weeks. Relative to EX, the change in steps/day at 20 weeks was 1994 (-40.27, 4028) higher for EX+NEPA. For sedentary time at close-out, the EX+NEPA group was -6.8 (-45.2, 31.6) min/day relative to EX. The between-group differences for systolic and diastolic blood pressure were -9.9 (-19.6, -0.3) and -1.8 (-6.9, 3.3) mmHg, respectively. CONCLUSION: The addition of wearable technology intervention appeared to positively influence daily activity patterns and changes in blood pressure - potentially improving risk factors for CVD. A fully powered randomized trial is needed to ultimately test this hypothesis.

Current Epidemiology of Surgical Sepsis: Discordance Between Inpatient Mortality and 1-year Outcomes.

OBJECTIVE: We sought to compare traditional inpatient outcomes to long-term functional outcomes and mortality of surgical intensive care unit (SICU) patients with sepsis. SUMMARY OF BACKGROUND DATA: As inpatient sepsis mortality declines, an increasing number of initial sepsis survivors now progress into a state of chronic critical illness (CCI) and their post-discharge outcomes are unclear. METHODS: We performed a prospective, longitudinal cohort study of SICU patients with sepsis. RESULTS: Among this recent cohort of 301 septic SICU patients, 30-day mortality was 9.6%. Only 13 (4%) patients died within 14 days, primarily of refractory multiple organ failure (62%). The majority (n = 189, 63%) exhibited a rapid recovery (RAP), whereas 99 (33%) developed CCI. CCI patients were older, with greater comorbidities, and more severe and persistent organ dysfunction than RAP patients (all P < 0.01). At 12 months, overall cohort performance status was persistently worse than presepsis baseline (WHO/Zubrod score 1.4 ±â€Š0.08 vs 2.2 ±â€Š0.23, P > 0.0001) and mortality was 20.9%. Of note at 12 months, the CCI cohort had persistent severely impaired performance status and a much higher mortality (41.4%) than those with RAP (4.8%) after controlling for age and comorbidity burden (Cox hazard ratio 1.27; 95% confidence interval, 1.14-1.41, P < 0.0001). Among CCI patients, independent risk factors for death by 12 months included severity of comorbidities and persistent organ dysfunction (sequential organ failure assessment ≥6) at day 14 after sepsis onset. CONCLUSIONS: There is discordance between low inpatient mortality and poor long-term outcomes after surgical sepsis, especially among older adults, increasing comorbidity burden and patients that develop CCI. This represents important information when discussing expected outcomes of surgical patients who experience a complicated clinical course owing to sepsis.

Prognostic value of NT-proBNP levels in the acute phase of sepsis on lower long-term physical function and muscle strength in sepsis survivors.

BACKGROUND: Sepsis survivors often develop chronic critical illness (CCI) and demonstrate the persistent inflammation, immunosuppression, and catabolism syndrome predisposing them to long-term functional limitations and higher mortality. There is a need to identify biomarkers that can predict long-term worsening of physical function to be able to act early and prevent mobility loss. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-accepted biomarker of cardiac overload, but it has also been shown to be associated with long-term physical function decline. We explored whether NT-proBNP blood levels in the acute phase of sepsis are associated with physical function and muscle strength impairment at 6 and 12 months after sepsis onset. METHODS: This is a retrospective analysis conducted in 196 sepsis patients (aged 18-86 years old) as part of the University of Florida (UF) Sepsis and Critical Illness Research Center (SCIRC) who consented to participate in the 12-month follow-up study. NT-proBNP was measured at 24 h after sepsis onset. Patients were followed to determine physical function by short physical performance battery (SPPB) test score (scale 0 to12-higher score corresponds with better physical function) and upper limb muscle strength by hand grip strength test (kilograms) at 6 and 12 months. We used a multivariate linear regression model to test an association between NT-proBNP levels, SPPB, and hand grip strength scores. Missing follow-up data or absence due to death was accounted for by using inverse probability weighting based on concurrent health performance status scores. Statistical significance was set at p ≤ 0.05. RESULTS: After adjusting for covariates (age, gender, race, Charlson comorbidity index, APACHE II score, and presence of CCI condition), higher levels of NT-proBNP at 24 h after sepsis onset were associated with lower SPPB scores at 12 months (p < 0.05) and lower hand grip strength at 6-month (p < 0.001) and 12-month follow-up (p < 0.05). CONCLUSIONS: NT-proBNP levels during the acute phase of sepsis may be a useful indicator of higher risk of long-term impairments in physical function and muscle strength in sepsis survivors.

Multimodal Intervention to Improve Functional Status in Hypertensive Older Adults: A Pilot Randomized Controlled Trial.

This pilot randomized controlled trial (RCT) was designed to provide the preliminary data necessary to conduct a full-scale trial to compare the efficacy of differing first-line antihypertensive medications in improving functional status in older adults, when combined with exercise. The primary objectives were to assess study feasibility, safety, and protocol integrity. Dependent outcomes included gait speed, exercise capacity, body composition, and systemic cardiometabolic biomarkers. Thirty-one physically inactive older adults (70.6 ± 6.1 years) with hypertension and functional limitations were randomly assigned to 1) Perindopril (8 mg/day n = 10), 2) Losartan (100 mg/day; n = 13), or 3) Hydrochlorothiazide (HCTZ: 25 mg/day; n = 8). Participants were also assigned to a 24-week multimodal exercise intervention, separated into an aerobic and concurrent (aerobic + resistance) phase to evaluate potential mode effects. Retention was 84% (26/31), and compliance was >90% and >79% with medication and exercise, respectively. A total of 29 adverse events (Perindopril = 5; Losartan = 12; HCTZ = 11) and one unrelated serious adverse event were observed throughout the trial. Overall, this pilot RCT provided critical data and identified several challenges to ultimately designing and implementing a fully powered trial.

Blood-Flow Restriction Resistance Exercise for Older Adults with Knee Osteoarthritis: A Pilot Randomized Clinical Trial.

In a pilot randomized clinical trial, participants aged ≥60 years (n = 35) with physical limitations and symptomatic knee osteoarthritis (OA) were randomized to 12 weeks of lower-body low-load resistance training with blood-flow restriction (BFR) or moderate-intensity resistance training (MIRT) to evaluate changes in muscle strength, pain, and physical function. Four exercises were performed three times per week to volitional fatigue using 20% and 60% of one repetition maximum (1RM). Study outcomes included knee extensor strength, gait speed, Short Physical Performance Battery (SPPB) performance, and pain via the Western Ontario and McMaster Universities OA Index (WOMAC). Per established guidance for pilot studies, primary analyses for the trial focused on safety, feasibility, and effect sizes/95% confidence intervals of dependent outcomes to inform a fully-powered trial. Across three speeds of movement, the pre- to post-training change in maximal isokinetic peak torque was 9.96 (5.76, 14.16) Nm while the mean difference between groups (BFR relative to MIRT) was -1.87 (-10.96, 7.23) Nm. Most other directionally favored MIRT, though more spontaneous reports of knee pain were observed (n = 14) compared to BFR (n = 3). BFR may have lower efficacy than MIRT in this context-though a fully-powered trial is needed to definitively address this hypothesis.

The Development of Chronic Critical Illness Determines Physical Function, Quality of Life, and Long-Term Survival Among Early Survivors of Sepsis in Surgical ICUs.

OBJECTIVES: This study sought to examine mortality, health-related quality of life, and physical function among sepsis survivors who developed chronic critical illness. DESIGN: Single-institution, prospective, longitudinal, observational cohort study assessing 12-month outcomes. SETTING: Two surgical/trauma ICUs at an academic tertiary medical and level 1 trauma center. PATIENTS: Adult critically ill patients that survived 14 days or longer after sepsis onset. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Baseline patient characteristics and function, sepsis severity, and clinical outcomes of the index hospitalization were collected. Follow-up physical function (short physical performance battery; Zubrod; hand grip strength) and health-related quality of life (EuroQol-5D-3L, Short Form-36) were measured at 3, 6, and 12 months. Hospital-free days and mortality were determined at 12 months. We compared differences in long-term outcomes between subjects who developed chronic critical illness (≥ 14 ICU days with persistent organ dysfunction) versus those with rapid recovery. The cohort consisted of 173 sepsis patients; 63 (36%) developed chronic critical illness and 110 (64%) exhibited rapid recovery. Baseline physical function and health-related quality of life did not differ between groups. Those who developed chronic critical illness had significantly fewer hospital-free days (196 ± 148 vs 321 ± 65; p < 0.0001) and reduced survival at 12-months compared with rapid recovery subjects (54% vs 92%; p < 0.0001). At 3- and 6-month follow-up, chronic critical illness patients had significantly lower physical function (3 mo: short physical performance battery, Zubrod, and hand grip; 6 mo: short physical performance battery, Zubrod) and health-related quality of life (3- and 6-mo: EuroQol-5D-3L) compared with patients who rapidly recovered. By 12-month follow-up, chronic critical illness patients had significantly lower physical function and health-related quality of life on all measures. CONCLUSIONS: Surgical patients who develop chronic critical illness after sepsis exhibit high healthcare resource utilization and ultimately suffer dismal long-term clinical, functional, and health-related quality of life outcomes. Further understanding of the mechanisms driving the development and persistence of chronic critical illness will be necessary to improve long-term outcomes after sepsis.

Chronic Critical Illness and the Persistent Inflammation, Immunosuppression, and Catabolism Syndrome.

Dysregulated host immune responses to infection often occur, leading to sepsis, multiple organ failure, and death. Some patients rapidly recover from sepsis, but many develop chronic critical illness (CCI), a debilitating condition that impacts functional outcomes and long-term survival. The "Persistent Inflammation, Immunosuppression, and Catabolism Syndrome" (PICS) has been postulated as the underlying pathophysiology of CCI. We propose that PICS is initiated by an early genomic and cytokine storm in response to microbial invasion during the early phase of sepsis. However, once source control, antimicrobial coverage, and supportive therapies have been initiated, we propose that the persistent inflammation in patients developing CCI is a result of ongoing endogenous alarmin release from damaged organs and loss of muscle mass. This ongoing alarmin and danger-associated molecular pattern signaling causes chronic inflammation and a shift in bone marrow stem cell production toward myeloid cells, contributing to chronic anemia and lymphopenia. We propose that therapeutic interventions must target the chronic organ injury and lean tissue wasting that contribute to the release of endogenous alarmins and the expansion and deposition of myeloid progenitors that are responsible for the propagation and persistence of CCI.

Alcohol use among college athletes: do intercollegiate, club, or intramural student athletes drink differently?

BACKGROUND: Varsity student athletes are a high-risk drinking group, exhibiting a greater propensity to binge drink than their non-sport peers. Moreover, as intercollegiate athletic involvement increases, so too does alcohol consumption. There is little research, however, which examines drinking behaviors of students who participate in nonvarsity athletics. OBJECTIVES: Identify differences in alcohol-related behaviors and associated consequences among U.S. varsity, club, and intramural athletes, and nonathlete college students. METHODS: Secondary data analysis of the 2011 National College Health Assessment (n = 29,939). RESULTS: Intramural athletes binge drank more frequently (M = 1.1, SD = 1.7) than club athletes (M = 1.0, SD = 1.6), intercollegiate athletes (M = 0.9, SD = 1.5), and nonathletes (M = 0.6, SD = 1.3) and also experienced greater alcohol-related consequences. Intramural athletes consumed the most during their last drinking episode (M = 4.1, SD = 4.0) and reached the highest blood alcohol concentration (BAC) (M = 0.062, SD = 0.09).Compared to club and varsity athletes [M = 0.8, SD = 1.4; t (8,131) = -9.6, p < .001], intramural-only athletes reported binge drinking significantly more frequently (M = 1.2, SD = 1.7) and also reached significantly higher BACs during most recent drinking episode (M = 0.064, SD = 0.08) than organized sport athletes [M = 0.057, SD = 0.08; t (8,050) = -3.0, p = .003]. CONCLUSIONS: Intramural athletes represent a higher-risk drinking group than other athlete and nonathlete college students. Future research should investigate factors contributing to drinking differences among different athlete groups.

A field-based community assessment of intoxication levels across college football weekends: does it matter who's playing?

While alcohol consumption has been consistently linked to college football games in the United States, this literature lacks (a) field-based event-level analyses; (b) assessments of the context of drinking, such as days leading to an event, that occurs in conjunction with a contest; (c) investigations of non-student drinking; and (d) objective assessments of opponent rating. Therefore, the present study: (1) examines the extent to which breath alcohol concentrations (BrAC) among restaurant and bar district patrons differ for low- and high-profile games and (2) explores the relationship between an objective rating of a team's opponent and BrAC levels. Data were collected throughout the fall 2011 football season via six anonymous field studies in a bar district within a southeastern college community. During low-profile game weekends, respondents recorded significantly lower BrAC levels than those during high-profile game weekends. Additionally, there was a positive correlation between opponent rating and BrAC levels, such that mean BrAC readings were highest prior to the game featuring the highest rated opponent. Overall, participants exhibited significantly higher BrACs when a higher-rated opponent was playing that weekend. When resources (money, manpower) are limited, community-based prevention and enforcement efforts should occur during the weekends surrounding higher-profile games.

Validation of a cardiorespiratory fitness assessment for firefighters.

Currently, a submaximal protocol is used to measure cardiorespiratory fitness in firefighters by estimating their true aerobic capacity (V[Combining Dot Above]O2max); however, this submaximal test has not been cross-validated among firefighters. Thirty firefighters (85% male, 15% female), completed the submaximal protocol and the maximal (Bruce) treadmill protocol on separate occasions. Pearson's correlation analyses between the submaximal and Bruce protocol revealed a significant moderate positive correlation (r = 0.635, p = 0.005). The range of mean V[Combining Dot Above]O2max values and SDs produced from the submaximal and maximal protocols varied greatly (35.4-50.9 vs. 28.6-58.4 ml·kg·min, and SD of 3.91 vs. 7.22, respectively). The submaximal V[Combining Dot Above]O2 test underestimated the true V[Combining Dot Above]O2max in the majority of firefighters (72.4%) and overestimated the true V[Combining Dot Above]O2max in the remainder of firefighters. Participants with a higher body fat percentage were more likely (p = 0.0157) to have an overestimated true V[Combining Dot Above]O2max than those with a lower-body fat percentage. Our results indicate the current submaximal V[Combining Dot Above]O2 test used to measure cardiorespiratory fitness in firefighters is an improvement over previous protocols. However, our findings also show that the accuracy of this submaximal test for predicting the true V[Combining Dot Above]O2max in firefighters is questionable, and may not identify firefighters who possess substandard cardiorespiratory fitness, particularly in those with a higher percentage of body fat. Thus, the results of this study indicate that improvements to the current Fire Service Joint Management, Wellness & Fitness Initiative (WFI) V[Combining Dot Above]O2 assessment is still needed to accurately reflect the true V[Combining Dot Above]O2max of individual firefighters.

Validity and reliability reporting practices in the field of health education and behavior: a review of seven journals.

Health education and behavior researchers and practitioners often develop, adapt, or adopt surveys/scales to quantify and measure cognitive, behavioral, emotional, and psychosocial characteristics. To ensure the integrity of data collected from these scales, it is vital that psychometric properties (i.e., validity and reliability) be assessed. The purpose of this investigation was to (a) determine the frequency with which published articles appearing in health education and behavior journals report the psychometric properties of the scales/subscales employed and (b) outline the methods used to determine the reliability and validity of the scores produced. The results reported herein are based on a final sample of 967 published articles, spanning seven prominent health education and behavior journals between 2007 and 2010. Of the 967 articles examined, an exceedingly high percentage failed to report any validity (ranging from 40% to 93%) or reliability (ranging from 35% to 80%) statistics in their articles. For health education/behavior practitioners and researchers to maximize the utility and applicability of their findings, they must evaluate the psychometric properties of the instrument employed, a practice that is currently underrepresented in the literature. By not ensuring the instruments employed in a given study were able to produce accurate and consistent scores, researchers cannot be certain they actually measured the behaviors and/or constructs reported.

Gender differences in the associations among body mass index, weight loss, exercise, and drinking among college students.

OBJECTIVE: To explore gender differences regarding weight management behaviors of college drinkers. PARTICIPANTS: Nationally representative sample of college students from the fall 2008 American College Health Association's National College Health Assessment II (N = 26,062 students). METHODS: Structural equation modeling was used to examine potential gender differences in associations among exercise, weight loss behaviors, and alcohol use. RESULTS: Critical ratio tests revealed that associations between exercise and weight loss behaviors were more strongly correlated among females as compared with males. For females, there was a small negative association between exercise and drinking behaviors; in contrast, for males, there was a positive relationship between exercise and alcohol use. Weight loss behaviors were positively associated with drinking for both female and male students; however, the association was significantly stronger for females. CONCLUSIONS: This investigation furthers previous research on drunkorexia and also sheds additional light on the gender-based differences in weight management behaviors of drinkers.

Appropriate terminology for the alcohol, eating, and physical activity relationship.

"Drunkorexia" merges prior literature identifying positive relationships between (a) alcohol use/abuse and disordered eating/eating disorders, (b) alcohol use/abuse and physical activity, and (c) disordered eating/eating disorders and physical activity. The term, highlighting an individual's proactive and/or reactive weight management behaviors (ie, disordered eating, physical activity) in relation to alcohol consumption, originated in news editorials and has recently gained recognition via use in scholarly publications. The purpose of this commentary is to recommend discontinuing use of the term "drunkorexia" due to (a) inconsistent definitions of drunkorexia across investigations, (b) drunkorexia being a misnomer, and (c) the medical community's lack of recognition/acceptance of drunkorexia. Because the behaviors encompassed by drunkorexia are of concern to researchers and health professionals, future investigations are still warranted. However, until a medically recognized term/phrase is accepted, scholars should utilize more appropriate characterizations such as "weight-conscious drinkers," "weight management behaviors of drinkers," or "Eating Disorders Not Otherwise Specified" (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision).

The impact of pregaming on subsequent blood alcohol concentrations: an event-level analysis.

Pregaming has been highlighted as an especially deleterious college drinking ritual. The present study assessed (a) event-level associations between pregaming and biologic samples of blood alcohol concentration (BrAC) and (b) the impact of one's alcohol-related behaviors (measured by AUDIT-C scores) on the likelihood that respondents would report pregaming prior to a night out drinking. The sample included adult (n=1029; collegiate and non-college-affiliated) bar patrons in a southeastern college community. Multiple and linear regressions were conducted to determine the association between pregaming and BrAC levels, and pregaming and the presence of an alcohol use disorder, respectively. After controlling for the influence of time of data collection, gender, age, college student status, and ethnicity, the linear regression model explained 15.5% (R2=.155) of the variance in BrAC levels (F (10, 915)=16.838, p<0.001), of which 10.8% was accounted for by self-reported pregaming alone. Furthermore, pregamers exhibited significantly higher BrACs compared to non-pregamers (ß=.332, p<.001). Logistic regression analyses indicated that AUDIT-C scores were the only significant predictor of pregaming status (OR=1.305, Wald=64.843), such that respondents with higher AUDIT-C scores (B=0.266) were more likely to pregame. This event-level study highlights the practice of pregaming as an insidious behavior associated with enhanced levels of drinking behavior and overall intoxication.

The impact of alcohol on Alzheimer's disease: a systematic review.

Currently, there is discrepancy regarding alcohol's impact on Alzheimer's disease (AD). Consequently, the purpose of this systematic review was to determine whether alcohol serves as a protective agent against the development of AD, as well as whether protective effects are influenced by quantity and/or frequency of drinking. Adapted versions of the Matrix Method and PRISMA guidelines were used in order to identify, organize, and synthesize relevant research. Overall, there is no consensus regarding alcohol's impact on AD. Specifically, seven articles suggested drinking alcohol decreases the risk of AD, three studies found drinking led to an increased risk of AD, and yet another nine reported alcohol had no impact on AD. Validity and consistency of both alcohol and AD measures across studies represents a severe limitation. Prior to the development of standards and/or clinical recommendations, more investigations into the association between alcohol and AD are necessary. Considering the current evidence base, alcohol should not be used as a means to decrease risk of developing AD.