Hydration

Guidelines for Perioperative Care in Elective Rectal/Pelvic Surgery: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations

J. Nygren, J. Thacker, F. Carli +6 more · World Journal of Surgery · 2012 · 2,174 citations

This meta-analysis and expert consensus found that a bundle of ~20 perioperative interventions—including preoperative counselling, carbohydrate loading, avoiding bowel prep, early feeding, and early mobilisation—reduces hospital stay by 2–3 days and complication rates by 30–50% in elective rectal/pelvic surgery, but many elements need modification for pelvic (vs. colonic) procedures due to higher complication rates and unique risks like nerve injury and urinary retention.

CDC Clinical Practice Guideline for Prescribing Opioids for Pain<b>—</b>United States, 2022

Deborah Dowell, Kathleen Ragan, Christopher M. Jones +2 more · MMWR Recommendations and Reports · 2022 · 1,585 citations

This comprehensive guideline, based on a systematic review of evidence, recommends prioritizing non-opioid therapies for pain, using the lowest effective opioid doses for the shortest durations when necessary, and emphasizing shared decision-making and careful risk assessment, which is crucial for anyone considering personal pain management strategies.

Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline

Dennis M. Styne, Silva Arslanian, Ellen L. Connor +4 more · The Journal of Clinical Endocrinology & Metabolism · 2017 · 1,253 citations

This clinical practice guideline synthesises evidence from systematic reviews and individual studies to recommend that pediatric obesity be diagnosed using BMI percentiles, prevented through family-centred lifestyle changes (≥20–60 minutes of vigorous activity daily, limited screen time, healthy sleep patterns), and treated with intensive lifestyle modification first, reserving pharmacotherapy for those who fail lifestyle changes and bariatric surgery only for mature adolescents with extreme obesity (BMI >40 kg/m² or >35 kg/m² with severe comorbidities).

The clinician’s guide to prevention and treatment of osteoporosis

Meryl S. LeBoff, S. L. Greenspan, Karl Insogna +4 more · Osteoporosis International · 2022 · 1,284 citations

This comprehensive guide synthesizes evidence and expert opinion to provide actionable recommendations for preventing, diagnosing, and treating osteoporosis in adults aged 50 and older, emphasizing that lifestyle interventions (calcium, vitamin D, exercise, fall prevention) are foundational, and effective medications can dramatically reduce fracture risk, which is crucial for anyone looking to understand and manage their personal bone health.

Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study Of Liver Diseases and the European Association for the Study of the Liver

Hendrik Vilstrup, Piero Amodio, Jasmohan S. Bajaj +5 more · Hepatology · 2014 · 2,025 citations

This joint clinical guideline synthesises the best available evidence on diagnosing, classifying, and treating hepatic encephalopathy (HE) in people with chronic liver disease — a condition that impairs brain function and dramatically reduces quality of life, but which has historically been managed inconsistently due to poor standardisation across studies and clinical settings.

Physical education, school physical activity, school sports and academic performance

François Trudeau, Roy J. Shephard · International Journal of Behavioral Nutrition and Physical Activity · 2008 · 865 citations

Adding up to one hour per day of physical activity to the school curriculum does not harm academic performance, and may produce small improvements in grade point average, concentration, and classroom behaviour — meaning you can increase physical activity without sacrificing cognitive productivity.

The Patient Who Falls

Mary E. Tinetti, C. T. Sudhir Kumar · JAMA · 2010 · 983 citations

Falls are a major health concern for older adults, and this review synthesizes evidence showing that addressing multiple personal risk factors simultaneously (like improving strength and balance, reviewing medications, and correcting vision) is the most effective strategy to reduce fall rates, while Vitamin D may help prevent fractures in at-risk older men.

The Impact of Physical Exercise on Oxidative and Nitrosative Stress: Balancing the Benefits and Risks

Qing Meng, Chun-Hsien Su · Antioxidants · 2024 · 68 citations

This review comprehensively evaluates the effects of physical exercise on oxidative and nitrosative stress, mainly focusing on the role of antioxidants. Using a narrative synthesis approach, data from empirical studies, reviews, systematic reviews, and meta-analyses published between 2004 and 2024 were collated from databases like PubMed, EBSCO (EDS), and Google Scholar, culminating in the inclusion of 41 studies. The quality of these studies was rigorously assessed to ensure the clarity of objectives, coherence in arguments, comprehensive literature coverage, and depth of critical analysis. Findings revealed that moderate exercise enhances antioxidant defenses through hormesis, while excessive exercise may exacerbate oxidative stress. The review also highlights that while natural dietary antioxidants are beneficial, high-dose supplements could impede the positive adaptations to exercise. In conclusion, the review calls for more focused research on tailored exercise and nutrition plans to further understand these complex interactions and optimize the health outcomes for athletes and the general population.

A mind-brain-body dataset of MRI, EEG, cognition, emotion, and peripheral physiology in young and old adults

Anahit Babayan, Miray Erbey, Deniz Kumral +71 more · Scientific Data · 2019 · 399 citations

This paper describes a comprehensive public dataset of brain imaging (MRI, EEG), physiological measures, cognitive test results, and psychological questionnaires collected from 227 healthy young and elderly adults, providing a rich resource for understanding the complex interplay between mind, brain, and body, which can inform what to measure in personal experiments.

World guidelines for falls prevention and management for older adults: a global initiative

Manuel Montero‐Odasso, Nathalie van der Velde, Finbarr C. Martin +97 more · Age and Ageing · 2022 · 1,434 citations

This international guideline, based on expert consensus and a systematic review of evidence, recommends that all older adults receive advice on falls prevention and physical activity, and that those at high risk undergo a comprehensive multifactorial assessment followed by personalised, multidomain interventions—but the evidence base is heterogeneous and effect sizes vary widely across settings.

Oxidative Stress in Schizophrenia

Iztok Grabnar, Tomaž Vovk, Blanka Kores Plesničar +1 more · Current Neuropharmacology · 2011 · 252 citations

Increasing evidence indicates that oxidative damage exists in schizophrenia. Available literature about possible mechanisms of oxidative stress induction was reviewed. Furthermore, possibilities of measuring biomarkers of schizophrenia outside the central nervous system compartment, their specificity for different types of schizophrenia and potential therapeutic strategies to prevent oxidative injuries in schizophrenia were discussed. Data were extracted from published literature found in Medline, Embase, Biosis, Cochrane and Web of Science, together with hand search of references. Search terms were: schizophrenia, oxidative stress, antipsychotics, antioxidants and fatty acids. Finding a sensitive, specific and non invasive biomarker of schizophrenia, which could be measured in peripheral tissue, still stays an important task. Antioxidant enzymes, markers of lipid peroxidation, oxidatively modified proteins and DNA are most commonly used. As it considers the supplemental therapy, according to our meta-analysis vitamin E could potentially improve tardive dyskinesia, while for the effect of therapy with polyunsaturated fatty acids there is no clear evidence. Oxidative stress is a part of the pathology in schizophrenia and appears as a promising field to develop new therapeutic strategies. There is a need for well designed, placebo controlled trials with supplementation therapy in schizophrenia.

The effect of oxytocin nasal spray on social interaction deficits observed in young children with autism: a randomized clinical crossover trial

Chathuri Yatawara, Stewart Einfeld, Ian B. Hickie +2 more · Molecular Psychiatry · 2015 · 347 citations

Interventions for autism are limited. The synthetic hormone oxytocin may provide a potential treatment to improve core social and behavioral difficulties in autism, but its efficacy has yet to be evaluated in young children who potentially may benefit to a greater extent. We investigated the efficacy, tolerability and safety of oxytocin treatment in young children with autism using a double-blind, randomized, placebo-controlled, crossover, clinical trial. Thirty-one children with autism received 12 International Units (IU) of oxytocin and placebo nasal spray morning and night (24 IU per day) for 5 weeks, with a 4-week washout period between each treatment. Compared with placebo, oxytocin led to significant improvements on the primary outcome of caregiver-rated social responsiveness. Overall, nasal spray was well tolerated, and the most common reported adverse events were thirst, urination and constipation. This study is the first clinical trial to support the potential of oxytocin as an early intervention for young children with autism to help improve social interaction deficits.

ESPEN guidelines on nutrition in cancer patients

Jann Arends, Patrick Bachmann, Vickie E. Baracos +19 more · Clinical Nutrition · 2016 · 2,944 citations

Canadian Network for Mood and Anxiety Treatments (<scp>CANMAT</scp>) and International Society for Bipolar Disorders (<scp>ISBD</scp>) 2018 guidelines for the management of patients with bipolar disorder

Lakshmi N. Yatham, Sidney H. Kennedy, Sagar V. Parikh +26 more · Bipolar Disorders · 2018 · 1,731 citations

This is a clinical practice guideline—not a single experiment—that synthesises decades of research to rank medications for bipolar disorder by efficacy, safety, and tolerability, providing a clear hierarchy of first-, second-, and third-line treatments for acute mania, acute depression, and long-term maintenance, which matters because it gives clinicians (and informed patients) an evidence-based roadmap for treatment decisions rather than relying on trial-and-error.

EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis

Gideon M. Hirschfield, Ulrich Beuers, Christophe Corpechot +4 more · Journal of Hepatology · 2017 · 1,422 citations

ESPEN guideline on clinical nutrition and hydration in geriatrics

Dorothee Volkert, Anne Marie Beck, Tommy Cederholm +11 more · Clinical Nutrition · 2018 · 1,357 citations

Effect of a Prebiotic Formulation on Frailty Syndrome: A Randomized, Double-Blind Clinical Trial

Cristina Buigues, Julio Fernández Garrido, Leo Pruimboom +7 more · International Journal of Molecular Sciences · 2016 · 217 citations

Aging can result in major changes in the composition and metabolic activities of bacterial populations in the gastrointestinal system and result in impaired function of the immune system. We assessed the efficacy of prebiotic Darmocare Pre(®) (Bonusan Besloten Vennootschap (BV), Numansdorp, The Netherlands) to evaluate whether the regular intake of this product can improve frailty criteria, functional status and response of the immune system in elderly people affected by the frailty syndrome. The study was a placebo-controlled, randomized, double blind design in sixty older participants aged 65 and over. The prebiotic product was composed of a mixture of inulin plus fructooligosaccharides and was compared with placebo (maltodextrin). Participants were randomized to a parallel group intervention of 13 weeks' duration with a daily intake of Darmocare Pre(®) or placebo. Either prebiotic or placebo were administered after breakfast (between 9-10 a.m.) dissolved in a glass of water carefully stirred just before drinking. The primary outcome was to study the effect on frailty syndrome. The secondary outcomes were effect on functional and cognitive behavior and sleep quality. Moreover, we evaluated whether prebiotic administration alters blood parameters (haemogram and biochemical analysis). The overall rate of frailty was not significantly modified by Darmocare Pre(®) administration. Nevertheless, prebiotic administration compared with placebo significantly improved two frailty criteria, e.g., exhaustion and handgrip strength (p < 0.01 and p < 0.05, respectively). No significant effects were observed in functional and cognitive behavior or sleep quality. The use of novel therapeutic approaches influencing the gut microbiota-muscle-brain axis could be considered for treatment of the frailty syndrome.

2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs)

Margo Mountjoy, Kathryn E. Ackerman, David M. Bailey +14 more · British Journal of Sports Medicine · 2023 · 539 citations

This consensus statement synthesises over 170 new studies since 2018 to define Relative Energy Deficiency in Sport (REDs) as a syndrome caused by low energy availability (LEA)—not eating enough to cover exercise energy expenditure—that impairs health and performance in both female and male athletes, and introduces a new clinical assessment tool and physiological model to guide diagnosis, prevention, and treatment.

Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

S. E. Inzucchi, Richard M. Bergenstal, John B. Buse +7 more · Diabetologia · 2012 · 3,931 citations

The Mood-Improving Effect of Viewing Images of Nature and Its Neural Substrate

Rikuto Yamashita, Chong Chen, Toshio Matsubara +13 more · International Journal of Environmental Research and Public Health · 2021 · 51 citations

Viewing images of nature for just three minutes significantly increased feelings of comfort and relaxation compared to viewing images of built environments (large effect), and this mood improvement was linked to reduced activity in a specific brain region—the right orbitofrontal cortex—suggesting a measurable neural mechanism for nature's calming effect.

Chapter 4European guidelinesfor the management of chronicnonspecific low back pain

Olavi Airaksinen, Jens Ivar Brox, Christine Cedraschi +9 more · European Spine Journal · 2006 · 2,593 citations

The two‐process model of sleep regulation: a reappraisal

Alexander A. Borbély, Serge Daan, Anna Wirz‐Justice +1 more · Journal of Sleep Research · 2016 · 1,540 citations

In the last three decades the two-process model of sleep regulation has served as a major conceptual framework in sleep research. It has been applied widely in studies on fatigue and performance and to dissect individual differences in sleep regulation. The model posits that a homeostatic process (Process S) interacts with a process controlled by the circadian pacemaker (Process C), with time-courses derived from physiological and behavioural variables. The model simulates successfully the timing and intensity of sleep in diverse experimental protocols. Electrophysiological recordings from the suprachiasmatic nuclei (SCN) suggest that S and C interact continuously. Oscillators outside the SCN that are linked to energy metabolism are evident in SCN-lesioned arrhythmic animals subjected to restricted feeding or methamphetamine administration, as well as in human subjects during internal desynchronization. In intact animals these peripheral oscillators may dissociate from the central pacemaker rhythm. A sleep/fast and wake/feed phase segregate antagonistic anabolic and catabolic metabolic processes in peripheral tissues. A deficiency of Process S was proposed to account for both depressive sleep disturbances and the antidepressant effect of sleep deprivation. The model supported the development of novel non-pharmacological treatment paradigms in psychiatry, based on manipulating circadian phase, sleep and light exposure. In conclusion, the model remains conceptually useful for promoting the integration of sleep and circadian rhythm research. Sleep appears to have not only a short-term, use-dependent function; it also serves to enforce rest and fasting, thereby supporting the optimization of metabolic processes at the appropriate phase of the 24-h cycle.

Exercise and Type 2 Diabetes

Sheri R. Colberg, Ronald J. Sigal, Bo Fernhall +6 more · Diabetes Care · 2010 · 1,923 citations

Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes, many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay type 2 diabetes, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower type 2 diabetes risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for PA with diabetes-related complications.

Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline

Derek LeRoith, Geert Jan Biessels, Susan S. Braithwaite +8 more · The Journal of Clinical Endocrinology & Metabolism · 2019 · 552 citations

OBJECTIVE: The objective is to formulate clinical practice guidelines for the treatment of diabetes in older adults. CONCLUSIONS: Diabetes, particularly type 2, is becoming more prevalent in the general population, especially in individuals over the age of 65 years. The underlying pathophysiology of the disease in these patients is exacerbated by the direct effects of aging on metabolic regulation. Similarly, aging effects interact with diabetes to accelerate the progression of many common diabetes complications. Each section in this guideline covers all aspects of the etiology and available evidence, primarily from controlled trials, on therapeutic options and outcomes in this population. The goal is to give guidance to practicing health care providers that will benefit patients with diabetes (both type 1 and type 2), paying particular attention to avoiding unnecessary and/or harmful adverse effects.

An overview of CO2 capture technologies

Niall MacDowell, Nick Florin, Antoine Buchard +7 more · Energy & Environmental Science · 2010 · 1,622 citations

In this paper, three of the leading options for large scale CO2 capture are reviewed from a technical perspective. We consider solvent-based chemisorption techniques, carbonate looping technology, and the so-called oxyfuel process. For each technology option, we give an overview of the technology, listing advantages and disadvantages. Subsequently, a discussion of the level of technological maturity is presented, and we conclude by identifying current gaps in knowledge and suggest areas with significant scope for future work. We then discuss the suitability of using ionic liquids as novel, environmentally benign solvents with which to capture CO2. In addition, we consider alternatives to simply sequestering CO2—we present a discussion on the possibility of recycling captured CO2 and exploiting it as a C1 building block for the sustainable manufacture of polymers, fine chemicals, and liquid fuels. Finally, we present a discussion of relevant systems engineering methodologies in carbon capture system design.

Stroke--1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders.

Heather Adams, Pujarini Dalai, J Easton +5 more · Stroke · 1989 · 1,547 citations

Glycaemic index methodology

Fred Brouns, I. Björck, Keith N. Frayn +4 more · Nutrition Research Reviews · 2005 · 1,038 citations

The glycaemic index (GI) concept was originally introduced to classify different sources of carbohydrate (CHO)-rich foods, usually having an energy content of >80 % from CHO, to their effect on post-meal glycaemia. It was assumed to apply to foods that primarily deliver available CHO, causing hyperglycaemia. Low-GI foods were classified as being digested and absorbed slowly and high-GI foods as being rapidly digested and absorbed, resulting in different glycaemic responses. Low-GI foods were found to induce benefits on certain risk factors for CVD and diabetes. Accordingly it has been proposed that GI classification of foods and drinks could be useful to help consumers make 'healthy food choices' within specific food groups. Classification of foods according to their impact on blood glucose responses requires a standardised way of measuring such responses. The present review discusses the most relevant methodological considerations and highlights specific recommendations regarding number of subjects, sex, subject status, inclusion and exclusion criteria, pre-test conditions, CHO test dose, blood sampling procedures, sampling times, test randomisation and calculation of glycaemic response area under the curve. All together, these technical recommendations will help to implement or reinforce measurement of GI in laboratories and help to ensure quality of results. Since there is current international interest in alternative ways of expressing glycaemic responses to foods, some of these methods are discussed.

Psychosocial and Psychophysiological Effects of Human-Animal Interactions: The Possible Role of Oxytocin

Andrea Beetz, Kerstin Uvnäs‐Moberg, Henri Julius +1 more · Frontiers in Psychology · 2012 · 841 citations

During the last decade it has become more widely accepted that pet ownership and animal assistance in therapy and education may have a multitude of positive effects on humans. Here, we review the evidence from 69 original studies on human-animal interactions (HAI) which met our inclusion criteria with regard to sample size, peer-review, and standard scientific research design. Among the well-documented effects of HAI in humans of different ages, with and without special medical, or mental health conditions are benefits for: social attention, social behavior, interpersonal interactions, and mood; stress-related parameters such as cortisol, heart rate, and blood pressure; self-reported fear and anxiety; and mental and physical health, especially cardiovascular diseases. Limited evidence exists for positive effects of HAI on: reduction of stress-related parameters such as epinephrine and norepinephrine; improvement of immune system functioning and pain management; increased trustworthiness of and trust toward other persons; reduced aggression; enhanced empathy and improved learning. We propose that the activation of the oxytocin system plays a key role in the majority of these reported psychological and psychophysiological effects of HAI. Oxytocin and HAI effects largely overlap, as documented by research in both, humans and animals, and first studies found that HAI affects the oxytocin system. As a common underlying mechanism, the activation of the oxytocin system does not only provide an explanation, but also allows an integrative view of the different effects of HAI.

Home-Based Physical Activity Intervention for Breast Cancer Patients

Bernardine M. Pinto, Georita Marie Frierson, Carolyn Rabin +2 more · Journal of Clinical Oncology · 2005 · 460 citations

PURPOSE: The efficacy of a home-based physical activity (PA) intervention for early-stage breast cancer patients was evaluated in a randomized controlled trial. PATIENTS AND METHODS: Eighty-six sedentary women (mean age, 53.14 years; standard deviation, 9.70 years) who had completed treatment for stage 0 to II breast cancer were randomly assigned to a PA or contact control group. Participants in the PA group received 12 weeks of PA counseling (based on the Transtheoretical Model) delivered via telephone, as well as weekly exercise tip sheets. Assessments were conducted at baseline, after treatment (12 weeks), and 6 and 9 month after baseline follow-ups. The post-treatment outcomes are reported here. RESULTS: Analyses showed that, after treatment, the PA group reported significantly more total minutes of PA, more minutes of moderate-intensity PA, and higher energy expenditure per week than controls. The PA group also out-performed controls on a field test of fitness. Changes in PA were not reflected in objective activity monitoring. The PA group was more likely than controls to progress in motivational readiness for PA and to meet PA guidelines. No significant group differences were found in body mass index and percent body fat. Post-treatment group comparisons revealed significant improvements in vigor and a reduction in fatigue in the PA group. There was a positive trend in intervention effects on overall mood and body esteem. CONCLUSION: The intervention successfully increased PA and improved fitness and specific aspects of psychological well-being among early-stage breast cancer patients. The success of a home-based PA intervention has important implications for promoting recovery in this population.

An integrative review of sensory marketing: Engaging the senses to affect perception, judgment and behavior

Aradhna Krishna · Journal of Consumer Psychology · 2011 · 1,511 citations

Abstract I define “sensory marketing” as “ marketing that engages the consumers' senses and affects their perception, judgment and behavior. ” From a managerial perspective, sensory marketing can be used to create subconscious triggers that characterize consumer perceptions of abstract notions of the product (e.g., its sophistication or quality). Given the gamut of explicit marketing appeals made to consumers every day, subconscious triggers which appeal to the basic senses may be a more efficient way to engage consumers. Also, these sensory triggers may result in consumers' self‐generation of (desirable) brand attributes, rather than those verbally provided by the advertiser. The understanding of these sensory triggers implies an understanding of sensation and perception as it applies to consumer behavior—this is the research perspective of sensory marketing. This review article presents an overview of research on sensory perception. The review also points out areas where little research has been done, so that each additional paper has a greater chance of making a bigger difference and sparking further research. It is quite apparent from the review that there still remains tremendous need for research within the domain of sensory marketing—research that can be very impactful.

Lignocellulosic biomass: a sustainable platform for the production of bio-based chemicals and polymers

Furkan H. Isikgor, C. Remzi Becer · Polymer Chemistry · 2015 · 2,647 citations

The ongoing research activities in the field of lignocellulosic biomass for production of value-added chemicals and polymers that can be utilized to replace petroleum-based materials are reviewed.

Internet Addiction and Relationships with Insomnia, Anxiety, Depression, Stress and Self-Esteem in University Students: A Cross-Sectional Designed Study

Farah Younes, Ghinwa Halawi, Khalil Jabbour +4 more · PLoS ONE · 2016 · 479 citations

BACKGROUND AND AIMS: Internet addiction (IA) could be a major concern in university medical students aiming to develop into health professionals. The implications of this addiction as well as its association with sleep, mood disorders and self-esteem can hinder their studies, impact their long-term career goals and have wide and detrimental consequences for society as a whole. The objectives of this study were to: 1) Assess potential IA in university medical students, as well as factors associated with it; 2) Assess the relationships between potential IA, insomnia, depression, anxiety, stress and self-esteem. METHODS: Our study was a cross-sectional questionnaire-based survey conducted among 600 students of three faculties: medicine, dentistry and pharmacy at Saint-Joseph University. Four validated and reliable questionnaires were used: the Young Internet Addiction Test, the Insomnia Severity Index, the Depression Anxiety Stress Scales (DASS 21), and the Rosenberg Self Esteem Scale (RSES). RESULTS: The average YIAT score was 30 ± 18.474; Potential IA prevalence rate was 16.8% (95% confidence interval: 13.81-19.79%) and it was significantly different between males and females (p-value = 0.003), with a higher prevalence in males (23.6% versus 13.9%). Significant correlations were found between potential IA and insomnia, stress, anxiety, depression and self-esteem (p-value < 0.001); ISI and DASS sub-scores were higher and self-esteem lower in students with potential IA. CONCLUSIONS: Identifying students with potential IA is important because this addiction often coexists with other psychological problems. Therefore, interventions should include not only IA management but also associated psychosocial stressors such as insomnia, anxiety, depression, stress, and self-esteem.

Reduced cognitive function during a heat wave among residents of non-air-conditioned buildings: An observational study of young adults in the summer of 2016

José Guillermo Cedeño Laurent, Augusta Williams, Youssef Oulhote +3 more · PLoS Medicine · 2018 · 192 citations

During a Boston heat wave, university students living in buildings without air conditioning showed 13% slower reaction times and 10% lower cognitive throughput compared to students with air conditioning, with effects worsening as indoor temperatures rose above 22–23°C — even in young, healthy adults.

Can exercise affect immune function to increase susceptibility to infection?

Richard J. Simpson, John P. Campbell, Maree Gleeson +5 more · PubMed · 2020 · 378 citations

Multiple studies in humans and animals have demonstrated the profound impact that exercise can have on the immune system. There is a general consensus that regular bouts of short-lasting (i.e. up to 45 minutes) moderate intensity exercise is beneficial for host immune defense, particularly in older adults and people with chronic diseases. In contrast, infection burden is reported to be high among high performance athletes and second only to injury for the number of training days lost during preparation for major sporting events. This has shaped the common view that arduous exercise (i.e. those activities practiced by high performance athletes/ military personnel that greatly exceed recommended physical activity guidelines) can suppress immunity and increase infection risk. However, the idea that exercise per se can suppress immunity and increase infection risk independently of the many other factors (e.g. anxiety, sleep disruption, travel, exposure, nutritional deficits, environmental extremes, etc.) experienced by these populations has recently been challenged. The purpose of this debate article was to solicit opposing arguments centered around this fundamental question in the exercise immunology field: can exercise affect immune function to increase susceptibility to infection. Issues that were contested between the debating groups include: (i) whether or not athletes are more susceptible to infection (mainly of the upper respiratory tract) than the general population; (ii) whether exercise per se is capable of altering immunity to increase infection risk independently of the multiple factors that activate shared immune pathways and are unique to the study populations involved; (iii) the usefulness of certain biomarkers and the interpretation of in vitro and in vivo data to monitor immune health in those who perform arduous exercise; and (iv) the quality of scientific evidence that has been used to substantiate claims for and against the potential negative effects of arduous exercise on immunity and infection risk. A key point of agreement between the groups is that infection susceptibility has a multifactorial underpinning. An issue that remains to be resolved is whether exercise per se is a causative factor of increased infection risk in athletes. This article should provide impetus for more empirical research to unravel the complex questions that surround this contentious issue in the field of exercise immunology.

Effects of Physical Activity and Inactivity on Muscle Fatigue

Gregory C. Bogdanis · Frontiers in Physiology · 2012 · 339 citations

The aim of this review was to examine the mechanisms by which physical activity and inactivity modify muscle fatigue. It is well known that acute or chronic increases in physical activity result in structural, metabolic, hormonal, neural, and molecular adaptations that increase the level of force or power that can be sustained by a muscle. These adaptations depend on the type, intensity, and volume of the exercise stimulus, but recent studies have highlighted the role of high intensity, short-duration exercise as a time-efficient method to achieve both anaerobic and aerobic/endurance type adaptations. The factors that determine the fatigue profile of a muscle during intense exercise include muscle fiber composition, neuromuscular characteristics, high energy metabolite stores, buffering capacity, ionic regulation, capillarization, and mitochondrial density. Muscle fiber-type transformation during exercise training is usually toward the intermediate type IIA at the expense of both type I and IIx myosin heavy-chain isoforms. High-intensity training results in increases of both glycolytic and oxidative enzymes, muscle capillarization, improved phosphocreatine resynthesis and regulation of K(+), H(+), and lactate ions. Decreases of the habitual activity level due to injury or sedentary lifestyle result in partial or even compete reversal of the adaptations due to previous training, manifested by reductions in fiber cross-sectional area, decreased oxidative capacity, and capillarization. Complete immobilization due to injury results in markedly decreased force output and fatigue resistance. Muscle unloading reduces electromyographic activity and causes muscle atrophy and significant decreases in capillarization and oxidative enzymes activity. The last part of the review discusses the beneficial effects of intermittent high-intensity exercise training in patients with different health conditions to demonstrate the powerful effect of exercise on health and well being.

Bifidobacterium longum 1714 as a translational psychobiotic: modulation of stress, electrophysiology and neurocognition in healthy volunteers

Andrew P. Allen, William Hutch, Yuliya Borre +7 more · Translational Psychiatry · 2016 · 497 citations

The emerging concept of psychobiotics-live microorganisms with a potential mental health benefit-represents a novel approach for the management of stress-related conditions. The majority of studies have focused on animal models. Recent preclinical studies have identified the B. longum 1714 strain as a putative psychobiotic with an impact on stress-related behaviors, physiology and cognitive performance. Whether such preclinical effects could be translated to healthy human volunteers remains unknown. We tested whether psychobiotic consumption could affect the stress response, cognition and brain activity patterns. In a within-participants design, healthy volunteers (N=22) completed cognitive assessments, resting electroencephalography and were exposed to a socially evaluated cold pressor test at baseline, post-placebo and post-psychobiotic. Increases in cortisol output and subjective anxiety in response to the socially evaluated cold pressor test were attenuated. Furthermore, daily reported stress was reduced by psychobiotic consumption. We also observed subtle improvements in hippocampus-dependent visuospatial memory performance, as well as enhanced frontal midline electroencephalographic mobility following psychobiotic consumption. These subtle but clear benefits are in line with the predicted impact from preclinical screening platforms. Our results indicate that consumption of B. longum 1714 is associated with reduced stress and improved memory. Further studies are warranted to evaluate the benefits of this putative psychobiotic in relevant stress-related conditions and to unravel the mechanisms underlying such effects.

A randomized, placebo-controlled trial investigating the acute and chronic benefits of American Ginseng (Cereboost®) on mood and cognition in healthy young adults, including in vitro investigation of gut microbiota changes as a possible mechanism of action

Lynne Bell, Adrian R. Whyte, Cindy Duysburgh +6 more · European Journal of Nutrition · 2021 · 44 citations

PURPOSE: Cereboost®, an American ginseng extract, has shown improved short-term memory and attention/alertness in healthy young and middle-aged individuals, potentially via modulation of the gut microbiome and upregulation of neurotransmitters such as acetylcholine. Here, we explored the effects of Cereboost® on cognition and mood in the first 6 h post intervention (acute), after 2 weeks daily supplementation (chronic), and whether 2 weeks daily supplementation altered the response to a single acute dose (acute-on-chronic). A concurrent in vitro study evaluated effects of repeated Cereboost® administration on human gut microbiota. METHODS: Cognitive effects of Cereboost® were assessed using a double-blind, randomized, placebo-controlled clinical trial, with 61 healthy young adults. Modulation of the gut microbiome was concurrently modelled using the Simulator of the Human Microbial Ecosystem (SHIME®), using a young adult donor. RESULTS: Consistent with previous findings, Cereboost® improved working memory and attention during the immediate postprandial period; effects that were amplified following two weeks' treatment (acute-on-chronic) compared to acute testing alone. Chronic supplementation improved cognition on an acetylcholine-sensitive attention task and improved mental fatigue and self-assurance aspects of mood. The parallel in vitro study revealed significantly increased acetate, propionate, and butyrate levels in simulated proximal and distal colon regions, linked with observed increases in Akkermansia muciniphila and Lactobacillus. CONCLUSION: This study confirmed the promising effects of Cereboost® on cognitive function and mood, while suggesting a possible link to alterations of the gut microbiome and modulation of acetylcholine. Further studies will be required to unravel the underlying mechanisms that are involved. REGISTRATION: The study was pre-registered at ClinicalTrials.gov on 6th July 2018 (Identifier: NCT03579095).

Status and perspectives of key materials for PEM electrolyzer

Kexin Zhang, Xiao Liang, Lina Wang +8 more · Nano Research Energy · 2022 · 460 citations

Proton exchange membrane water electrolyzer (PEMWE) represents a promising technology for the sustainable production of hydrogen, which is capable of efficiently coupling to intermittent electricity from renewable energy sources (e.g., solar and wind). The technology with compact stack structure has many notable advantages, including large current density, high hydrogen purity, and great conversion efficiency. However, the use of expensive electrocatalysts and construction materials leads to high hydrogen production costs and limited application. In this review, recent advances made in key materials of PEMWE are summarized. First, we present a brief overview about the basic principles, thermodynamics, and reaction kinetics of PEMWE. We then describe the cell components of PEMWE and their respective functions, as well as discuss the research status of key materials such as membrane, electrocatalysts, membrane electrode assemblies, gas diffusion layer, and bipolar plate. We also attempt to clarify the degradation mechanisms of PEMWE under a real operating environment, including catalyst degradation, membrane degradation, bipolar plate degradation, and gas diffusion layer degradation. We finally propose several future directions for developing PEMWE through devoting more efforts to the key materials.

Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008

Peter A. Ringleb, Marie Germaine Bousser · Cerebrovascular Diseases · 2008 · 2,497 citations

This article represents the update of the European Stroke Initiative Recommendations for Stroke Management. These guidelines cover both ischaemic stroke and transient ischaemic attacks, which are now considered to be a single entity. The article covers referral and emergency management, Stroke Unit service, diagnostics, primary and secondary prevention, general stroke treatment, specific treatment including acute management, management of complications, and rehabilitation.

ESPEN practical guideline: Clinical nutrition and hydration in geriatrics

Dorothee Volkert, Anne Marie Beck, Tommy Cederholm +10 more · Clinical Nutrition · 2022 · 403 citations

UEFA expert group statement on nutrition in elite football. Current evidence to inform practical recommendations and guide future research

James Collins, Ronald J. Maughan, Michael Gleeson +28 more · British Journal of Sports Medicine · 2020 · 269 citations

Football is a global game which is constantly evolving, showing substantial increases in physical and technical demands. Nutrition plays a valuable integrated role in optimising performance of elite players during training and match-play, and maintaining their overall health throughout the season. An evidence-based approach to nutrition emphasising, a 'food first' philosophy (ie, food over supplements), is fundamental to ensure effective player support. This requires relevant scientific evidence to be applied according to the constraints of what is practical and feasible in the football setting. The science underpinning sports nutrition is evolving fast, and practitioners must be alert to new developments. In response to these developments, the Union of European Football Associations (UEFA) has gathered experts in applied sports nutrition research as well as practitioners working with elite football clubs and national associations/federations to issue an expert statement on a range of topics relevant to elite football nutrition: (1) match day nutrition, (2) training day nutrition, (3) body composition, (4) stressful environments and travel, (5) cultural diversity and dietary considerations, (6) dietary supplements, (7) rehabilitation, (8) referees and (9) junior high-level players. The expert group provide a narrative synthesis of the scientific background relating to these topics based on their knowledge and experience of the scientific research literature, as well as practical experience of applying knowledge within an elite sports setting. Our intention is to provide readers with content to help drive their own practical recommendations. In addition, to provide guidance to applied researchers where to focus future efforts.

Carnosine Treatment for Gulf War Illness: A Randomized Controlled Trial

James N. Baraniuk, Suliman El-Amin, Rebecca Corey +2 more · Global Journal of Health Science · 2013 · 88 citations

About 25% of 1990-1991 Persian Gulf War veterans experience disabling fatigue, widespread pain, and cognitive dysfunction termed Gulf War illness (GWI) or Chronic Multisymptom Illness (CMI). A leading theory proposes that wartime exposures initiated prolonged production of reactive oxygen species (ROS) and central nervous system injury. The endogenous antioxidant L-carnosine (B-alanyl-L-histidine) is a potential treatment since it is a free radical scavenger in nervous tissue. To determine if nutritional supplementation with L-carnosine would significantly improve pain, cognition and fatigue in GWI, a randomized double blind placebo controlled 12 week dose escalation study involving 25 GWI subjects was employed. L-carnosine was given as 500, 1000, and 1500 mg increasing at 4 week intervals. Outcomes included subjective fatigue, pain and psychosocial questionnaires, and instantaneous fatigue and activity levels recorded by ActiWatch Score devices. Cognitive function was evaluated by WAIS-R digit symbol substitution test. Carnosine had 2 potentially beneficial effects: WAIS-R scores increased significantly, and there was a decrease in diarrhea associated with irritable bowel syndrome. No other significant incremental changes were found. Therefore, 12 weeks of carnosine (1500 mg) may have beneficial cognitive effects in GWI. Fatigue, pain, hyperalgesia, activity and other outcomes were resistant to treatment.

Study of the ketogenic agent AC-1202 in mild to moderate Alzheimer's disease: a randomized, double-blind, placebo-controlled, multicenter trial

Samuel T. Henderson, Janet L Vogel, L. Barr +3 more · Nutrition & Metabolism · 2009 · 537 citations

BACKGROUND: Alzheimer's disease (AD) is characterized by early and region-specific declines in cerebral glucose metabolism. Ketone bodies are produced by the body during glucose deprivation and are metabolized by the brain. An oral ketogenic compound, AC-1202, was tested in subjects with probable AD to examine if ketosis could improve cognitive performance. METHODS: Daily administration of AC-1202 was evaluated in 152 subjects diagnosed with mild to moderate AD in a US-based, 90-day, randomized, double-blind, placebo-controlled, parallel-group study. Subjects were on a normal diet and continued taking approved AD medications. Primary cognitive end points were mean change from Baseline in the AD Assessment Scale-Cognitive subscale (ADAS-Cog), and global scores in the AD Cooperative Study - Clinical Global Impression of Change (ADCS-CGIC). AC-1202 was compared to Placebo in several population groups, including: intention-to-treat (ITT), per protocol, and dosage compliant groups. Results were also stratified by APOE4 carriage status (a predefined analysis based on the epsilon 4 (E4) variant of the apolipoprotein E gene). This trial was registered with ClinicalTrials.gov, registry number NCT00142805, information available at http://clinicaltrials.gov/ct2/show/NCT00142805 RESULTS: AC-1202 significantly elevated a serum ketone body (beta-hydroxybutyrate) 2 hours after administration when compared to Placebo. In each of the population groups, a significant difference was found between AC-1202 and Placebo in mean change from Baseline in ADAS-Cog score on Day 45: 1.9 point difference, p = 0.0235 in ITT; 2.53 point difference, p = 0.0324 in per protocol; 2.6 point difference, p = 0.0215 in dosage compliant. Among participants who did not carry the APOE4 allele (E4(-)), a significant difference was found between AC-1202 and Placebo in mean change from Baseline in ADAS-Cog score on Day 45 and Day 90. In the ITT population, E4(-) participants (N = 55) administered AC-1202 had a significant 4.77 point difference in mean change from Baseline in ADAS-Cog scores at Day 45 (p = 0.0005) and a 3.36 point difference at Day 90 (p = 0.0148) compared to Placebo. In the per protocol population, E4(-) participants receiving AC-1202 (N = 37) differed from placebo by 5.73 points at Day 45 (p = 0.0027) and by 4.39 points at Day 90 (p = 0.0143). In the dosage compliant population, E4(-) participants receiving AC-1202 differed from placebo by 6.26 points at Day 45 (p = 0.0011, N = 38) and 5.33 points at Day 90 (p = 0.0063, N = 35). Furthermore, a significant pharmacologic response was observed between serum beta-hydroxybutyrate levels and change in ADAS-Cog scores in E4(-) subjects at Day 90 (p = 0.008). Adverse events occurred more frequently in AC-1202 subjects, were primarily restricted to the gastrointestinal system, and were mainly mild to moderate in severity and transient in nature. CONCLUSION: AC-1202 rapidly elevated serum ketone bodies in AD patients and resulted in significant differences in ADAS-Cog scores compared to the Placebo. Effects were most notable in APOE4(-) subjects who were dosage compliant.

Standards of Medical Care in Diabetes–2006

American Diabetes Association · Diabetes Care · 2006 · 974 citations

SIRT1 Is Essential for Normal Cognitive Function and Synaptic Plasticity

Shaday Michán, Yan Li, Maggie M Chou +16 more · Journal of Neuroscience · 2010 · 532 citations

Conservation of normal cognitive functions relies on the proper performance of the nervous system at the cellular and molecular level. The mammalian nicotinamide-adenine dinucleotide-dependent deacetylase SIRT1 impacts different processes potentially involved in the maintenance of brain integrity, such as chromatin remodeling, DNA repair, cell survival, and neurogenesis. Here we show that SIRT1 is expressed in neurons of the hippocampus, a key structure in learning and memory. Using a combination of behavioral and electrophysiological paradigms, we analyzed the effects of SIRT1 deficiency and overexpression on mouse learning and memory as well as on synaptic plasticity. We demonstrated that the absence of SIRT1 impaired cognitive abilities, including immediate memory, classical conditioning, and spatial learning. In addition, we found that the cognitive deficits in SIRT1 knock-out (KO) mice were associated with defects in synaptic plasticity without alterations in basal synaptic transmission or NMDA receptor function. Brains of SIRT1-KO mice exhibited normal morphology and dendritic spine structure but displayed a decrease in dendritic branching, branch length, and complexity of neuronal dendritic arbors. Also, a decrease in extracellular signal-regulated kinase 1/2 phosphorylation and altered expression of hippocampal genes involved in synaptic function, lipid metabolism, and myelination were detected in SIRT1-KO mice. In contrast, mice with high levels of SIRT1 expression in brain exhibited regular synaptic plasticity and memory. We conclude that SIRT1 is indispensable for normal learning, memory, and synaptic plasticity in mice.

A Multicomponent Intervention to Prevent Delirium in Hospitalized Older Patients

Sharon K. Inouye, Sidney T. Bogardus, Peter Charpentier +4 more · New England Journal of Medicine · 1999 · 2,895 citations

BACKGROUND: Since in hospitalized older patients delirium is associated with poor outcomes, we evaluated the effectiveness of a multicomponent strategy for the prevention of delirium. METHODS: We studied 852 patients 70 years of age or older who had been admitted to the general-medicine service at a teaching hospital. Patients from one intervention unit and two usual-care units were enrolled by means of a prospective matching strategy. The intervention consisted of standardized protocols for the management of six risk factors for delirium: cognitive impairment, sleep deprivation, immobility, visual impairment, hearing impairment, and dehydration. Delirium, the primary outcome, was assessed daily until discharge. RESULTS: Delirium developed in 9.9 percent of the intervention group as compared with 15.0 percent of the usual-care group, (matched odds ratio, 0.60; 95 percent confidence interval, 0.39 to 0.92). The total number of days with delirium (105 vs. 161, P=0.02) and the total number of episodes (62 vs. 90, P=0.03) were significantly lower in the intervention group. However, the severity of delirium and recurrence rates were not significantly different. The overall rate of adherence to the intervention was 87 percent, and the total number of targeted risk factors per patient was significantly reduced. Intervention was associated with significant improvement in the degree of cognitive impairment among patients with cognitive impairment at admission and a reduction in the rate of use of sleep medications among all patients. Among the other risk factors per patient there were trends toward improvement in immobility, visual impairment, and hearing impairment. CONCLUSIONS: The risk-factor intervention strategy that we studied resulted in significant reductions in the number and duration of episodes of delirium in hospitalized older patients. The intervention had no significant effect on the severity of delirium or on recurrence rates; this finding suggests that primary prevention of delirium is probably the most effective treatment strategy.

The Impact of Wearable Technologies in Health Research: Scoping Review

Sophie Huhn, Miriam Axt, Hanns‐Christian Gunga +9 more · JMIR mhealth and uhealth · 2022 · 337 citations

BACKGROUND: Wearable devices hold great promise, particularly for data generation for cutting-edge health research, and their demand has risen substantially in recent years. However, there is a shortage of aggregated insights into how wearables have been used in health research. OBJECTIVE: In this review, we aim to broadly overview and categorize the current research conducted with affordable wearable devices for health research. METHODS: We performed a scoping review to understand the use of affordable, consumer-grade wearables for health research from a population health perspective using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework. A total of 7499 articles were found in 4 medical databases (PubMed, Ovid, Web of Science, and CINAHL). Studies were eligible if they used noninvasive wearables: worn on the wrist, arm, hip, and chest; measured vital signs; and analyzed the collected data quantitatively. We excluded studies that did not use wearables for outcome assessment and prototype studies, devices that cost >€500 (US $570), or obtrusive smart clothing. RESULTS: We included 179 studies using 189 wearable devices covering 10,835,733 participants. Most studies were observational (128/179, 71.5%), conducted in 2020 (56/179, 31.3%) and in North America (94/179, 52.5%), and 93% (10,104,217/10,835,733) of the participants were part of global health studies. The most popular wearables were fitness trackers (86/189, 45.5%) and accelerometer wearables, which primarily measure movement (49/189, 25.9%). Typical measurements included steps (95/179, 53.1%), heart rate (HR; 55/179, 30.7%), and sleep duration (51/179, 28.5%). Other devices measured blood pressure (3/179, 1.7%), skin temperature (3/179, 1.7%), oximetry (3/179, 1.7%), or respiratory rate (2/179, 1.1%). The wearables were mostly worn on the wrist (138/189, 73%) and cost <€200 (US $228; 120/189, 63.5%). The aims and approaches of all 179 studies revealed six prominent uses for wearables, comprising correlations-wearable and other physiological data (40/179, 22.3%), method evaluations (with subgroups; 40/179, 22.3%), population-based research (31/179, 17.3%), experimental outcome assessment (30/179, 16.8%), prognostic forecasting (28/179, 15.6%), and explorative analysis of big data sets (10/179, 5.6%). The most frequent strengths of affordable wearables were validation, accuracy, and clinical certification (104/179, 58.1%). CONCLUSIONS: Wearables showed an increasingly diverse field of application such as COVID-19 prediction, fertility tracking, heat-related illness, drug effects, and psychological interventions; they also included underrepresented populations, such as individuals with rare diseases. There is a lack of research on wearable devices in low-resource contexts. Fueled by the COVID-19 pandemic, we see a shift toward more large-sized, web-based studies where wearables increased insights into the developing pandemic, including forecasting models and the effects of the pandemic. Some studies have indicated that big data extracted from wearables may potentially transform the understanding of population health dynamics and the ability to forecast health trends.

Thermoelectrics: From history, a window to the future

Davide Beretta, Neophytos Neophytou, James M. Hodges +13 more · Materials Science and Engineering R Reports · 2018 · 577 citations

Neuroscience of Exercise: From Neurobiology Mechanisms to Mental Health

Eduardo Matta Mello Portugal, Thais Cevada, Renato Sobral Monteiro-Júnior +5 more · Neuropsychobiology · 2013 · 309 citations

The neuroscience of exercise is a growing research area that is dedicated to furthering our understanding of the effects that exercise has on mental health and athletic performance. The present study examined three specific topics: (1) the relationship between exercise and mental disorders (e.g. major depressive disorder, dementia and Parkinson's disease), (2) the effects of exercise on the mood and mental health of athletes, and (3) the possible neurobiological mechanisms that mediate the effects of exercise. Positive responses to regular physical exercise, such as enhanced functional capacity, increased autonomy and improved self-esteem, are frequently described in the recent literature, and these responses are all good reasons for recommending regular exercise. In addition, physical exercise may improve both mood and adherence to an exercise program in healthy individuals and might modulate both the performance and mental health of athletes. Exercise is associated with the increased synthesis and release of both neurotransmitters and neurotrophic factors, and these increases may be associated with neurogenesis, angiogenesis and neuroplasticity. This review is a call-to-action that urges researchers to consider the importance of understanding the neuroscience of physical exercise and its contributions to sports science.

Reactive transport codes for subsurface environmental simulation

Carl I. Steefel, C.A.J. Appelo, Bhavna Arora +14 more · Computational Geosciences · 2014 · 805 citations

A general description of the mathematical and numerical formulations used in modern numerical reactive transport codes relevant for subsurface environmental simulations is presented. The formulations are followed by short descriptions of commonly used and available subsurface simulators that consider continuum representations of flow, transport, and reactions in porous media. These formulations are applicable to most of the subsurface environmental benchmark problems included in this special issue. The list of codes described briefly here includes PHREEQC, HPx, PHT3D, OpenGeoSys (OGS), HYTEC, ORCHESTRA, TOUGHREACT, eSTOMP, HYDROGEOCHEM, CrunchFlow, MIN3P, and PFLOTRAN. The descriptions include a high-level list of capabilities for each of the codes, along with a selective list of applications that highlight their capabilities and historical development.