Optimal Nutrition for Endurance Exercise: A Systematic Review

Introduction As fatigue in endurance events correlates with depletion of muscle glycogen, the traditional approach to nutritional support has been carbohydrate loading. However, there has been recent interest in improving athletic endurance performance by novel diets in the days to weeks prior to endurance events, the pre-event meal, and during exercise. Methods We searched PubMed and SCOPUS for randomized trials published from 1992-2017 with a primary endpoint of endurance performance. We identified 407 citations which were examined against our inclusion criteria of randomization or crossover allocation to diet and for which a primary outcome was endurance performance. Results Twenty full text articles met our inclusion criteria and were included in the present review. In the days to weeks prior to testing, one trial of a high-fat diet versus carbohydrate improved performance, the others were neutral. There was no benefit of substituting protein for carbohydrate during this time period, but almond intake did result in ergogenic benefits. In the pre-event meal, fat only showed ergogenic benefits when combined with carbohydrate intake. A single study suggested that vegetable-derived nitrates did provide benefit. During endurance events, partial substitution of carbohydrates with protein had varying results on performance and should be further examined. Conclusion Carbohydrates remain the best fuel source both before and during events for overall endurance performance compared to other macronutrients, including water. Partial substitution of carbohydrate with fat and protein immediately before and during events warrants further investigation. Additional trials on nitrates and almond consumption are also needed

Organic food and farming research needs in the UK:A report on a stakeholder participatory consultation process

During 2005 Defra commissioned a study to identify and analyse issues and aspirations that organic stakeholders felt should be addressed by publicly funded organic food and farming research in the UK. How this was undertaken is presented in this paper. A series of 12 workshops were undertaken with stakeholders throughout the UK. Nearly 300 stakeholders attended the workshops. These workshops used participatory approaches to identify and record the most important issues and aspirations from those attending. The use of a highly participatory style was greatly appreciated by stakeholders. In most cases the interaction between stakeholders worked well and resulted in lively discussions. The workshops have served to open up a useful dialogue between groups of stakeholders who do not normally communicate directly. They have produced a significant number of interesting and challenging issues and aspirations

“Cheating” In a Fast by Exercising After a Snack

As the prevalence of chronic diseases has increased, research has emerged supporting the utility of intermittent fasting in managing certain health conditions. Despite potential benefits, adhering to a fasting regimen can be difficult. PURPOSE: The purpose of this study was twofold. The first purpose was to describe how consuming a modest snack prior to exercise influences plasma glucose, beta-hydroxybutyrate and hunger in reference to fasting with and without exercise. The second purpose was to examine how exercising in a fasted state influences plasma glucose, beta-hydroxybutyrate and hunger. METHODS: A randomized crossover design with counterbalanced treatment conditions was used to compare the influence of fasting alone (control), fasting with exercise (exercise), and fasting with the addition of a snack immediately prior to exercise (snack/exercise). The effects of these interventions on beta-hydroxybutyrate levels, blood glucose, hunger, and mood were assessed. RESULTS: BHB was significantly higher in the exercise condition than control starting at 24 hrs to the end of the study (p \u3c 0.05). BHB levels between control and snack/exercise conditions were not different. Immediately after participants had exercised, blood glucose levels were higher in both the exercise and snack/exercise conditions than control (p \u3c 0.001). With the exception of one time point, there were no additional differences. In the exercise and snack/exercise conditions, hunger was significantly lower than control right after exercise (p = .0043 and p = .0003, respectively). Hunger was not different between the exercise and snack/exercise conditions at any time point. Mood was not different between conditions. CONCLUSIONS: Exercising after modest caloric intake produces BHB and glucose levels that are similar to fasting alone. Exercising without a snack briefly interrupts the fast but elevates BHB production starting around three hours after the exercise bout. Finally, mood was not different between any conditions and calls into question the assumption that a snack/exercise fasting protocol is in fact easier to adhere to

ZAK is required for doxorubicin, a novel ribotoxic stressor, to induce SAPK activation and apoptosis in HaCaT cells

Doxorubicin is an anthracycline drug that is one of the most effective and widely used anticancer agents for the treatment of both hematologic and solid tumors. The stress-activated protein kinases (SAPKs) are frequently activated by a number of cancer chemotherapeutics. When phosphorylated, the SAPKs initiate a cascade that leads to the production of proinflammatory cytokines. Some inhibitors of protein synthesis, known as ribotoxic stressors, coordinately activate SAPKs and lead to apoptotic cell death. We demonstrate that doxorubicin effectively inhibits protein synthesis, activates SAPKs, and causes apoptosis. Ribotoxic stressors share a common mechanism in that they require ZAK, an upstream MAP3K, to activate the pro-apoptotic and proinflammatory signaling pathways that lie downstream of SAPKs. By employing siRNA mediated knockdown of ZAK or administration of sorafenib and nilotinib, kinase inhibitors that have a high affinity for ZAK, we provide evidence that ZAK is required for doxorubicin-induced proinflammatory and apoptotic responses in HaCaT cells, a pseudo-normal keratinocyte cell line, but not in HeLa cells, a cancerous cell line. ZAK has two different isoforms, ZAK-α (91 kDa) and ZAK-β (51 kDa). HaCaT or HeLa cells treated with doxorubicin and immunoblotted for ZAK displayed a progressive decrease in the ZAK-α band and the appearance of ZAK-β bands of larger size. Abrogation of these changes after exposure of cells to sorafenib and nilotinib suggests that these alterations occur following stimulation of ZAK. We suggest that ZAK inhibitors such as sorafenib or nilotinib may be effective when combined with doxorubicin to treat cancer patients

Intractable Alcoholism in a Patient with a Levine Shunt

Ellen Shaw. M.D., Fellow in Hepatology: Mr. J is a forty-six-year-old white male who was initially seen on the medical service in July 1982. At that time he presented with hepatic encephalopathy, jaundice, and ascites. A liver biopsy was performed, confirming the clinical diagnosis of alcoholic hepatitis superimposed on cirrhosis. Following discharge it was difficult to maintain Mr. J as an outpatient. He did not follow dietary restrictions or take diuretics as prescribed. Additionally he was unable to control his drinking. Finally about a year ago a Levine shunt was implanted in an effort to control his ascites. Subsequently he did well for a period of several months. He was able to abstain from alcohol with a resulting decrease in his ascites and jaundice. Recently he has resumed drinking, with a return of his symptoms. He has missed his last several appointments in the clinic. Control of his medical problems remains problematic unless his alcohol abuse can be better controlled

Development of a Medication Monitoring System for an Integrated Multidisciplinary Program of Assertive Community Treatment (IMPACT) Team

Purpose: The primary goal was to improve medication management oversight for a severely mentally ill (SMI) community-based population by developing a medication monitoring system based on current guidelines to optimize pharmacotherapy and minimize potential medication-related adverse effects. The secondary goal was improvement in coordination of care between healthcare providers. Methods: Guidelines for medication used for psychiatric indications were reviewed. A database of medication for psychiatric indications with monitoring recommendation was developed. Results: Medication regimens for 68 members of the Integrated Multidisciplinary Program of Assertive Community Treatment (IMPACT) program qualified for review. Fourteen medications, carbamazepine, chlorpromazine, clozapine, fluphenazine and fluphenazine long-acting injections (LAI), haloperidol and haloperidol LAI, lithium, lurasidone, olanzapine, paliperidone and paliperidone LAI, perphenazine, quetiapine, risperidone and risperidone LAI, valproic acid/divalproex, and ziprasidone, were identified. In total, 111 medications are used on a monthly basis. Each member receives more than one medication qualifying for review. Additional monitoring parameters that were evaluated included changes in laboratory orders for members with insulin-dependent diabetes. Annual lipid panels were changed to every 6 months, if applicable. Conclusions and Future Directions: This medication monitoring program was developed to help ensure IMPACT members receive the most effective care and minimize potential medication-related adverse effects. The secondary goal was to improve coordination of care. Medication monitoring will be added as a continuous quality assurance measure. Lab results will be reviewed at least monthly. The medication monitoring program will be evaluated annually

Sampling-based Algorithms for Optimal Motion Planning

During the last decade, sampling-based path planning algorithms, such as Probabilistic RoadMaps (PRM) and Rapidly-exploring Random Trees (RRT), have been shown to work well in practice and possess theoretical guarantees such as probabilistic completeness. However, little effort has been devoted to the formal analysis of the quality of the solution returned by such algorithms, e.g., as a function of the number of samples. The purpose of this paper is to fill this gap, by rigorously analyzing the asymptotic behavior of the cost of the solution returned by stochastic sampling-based algorithms as the number of samples increases. A number of negative results are provided, characterizing existing algorithms, e.g., showing that, under mild technical conditions, the cost of the solution returned by broadly used sampling-based algorithms converges almost surely to a non-optimal value. The main contribution of the paper is the introduction of new algorithms, namely, PRM* and RRT*, which are provably asymptotically optimal, i.e., such that the cost of the returned solution converges almost surely to the optimum. Moreover, it is shown that the computational complexity of the new algorithms is within a constant factor of that of their probabilistically complete (but not asymptotically optimal) counterparts. The analysis in this paper hinges on novel connections between stochastic sampling-based path planning algorithms and the theory of random geometric graphs.Comment: 76 pages, 26 figures, to appear in International Journal of Robotics Researc

Combined Heat and Power: Effective Energy Solutions for a Sustainable Future

Combined Heat and Power (CHP) solutions represent a proven and effective near-term energy option to help the United States enhance energy efficiency, ensure environmental quality, promote economic growth, and foster a robust energy infrastructure. Using CHP today, the United States already avoids more than 1.9 Quadrillion British thermal units (Quads) of fuel consumption and 248 million metric tons of carbon dioxide (CO{sub 2}) emissions annually compared to traditional separate production of electricity and thermal energy. This CO{sub 2} reduction is the equivalent of removing more than 45 million cars from the road. In addition, CHP is one of the few options in the portfolio of energy alternatives that combines environmental effectiveness with economic viability and improved competitiveness. This report describes in detail the four key areas where CHP has proven its effectiveness and holds promise for the future as an: (1) Environmental Solution: Significantly reducing CO{sub 2} emissions through greater energy efficiency; (2) Competitive Business Solution: Increasing efficiency, reducing business costs, and creating green-collar jobs; (3) Local Energy Solution: Deployable throughout the US; and (4) Infrastructure Modernization Solution: Relieving grid congestion and improving energy security. CHP should be one of the first technologies deployed for near-term carbon reductions. The cost-effectiveness and near-term viability of widespread CHP deployment place the technology at the forefront of practical alternative energy solutions such as wind, solar, clean coal, biofuels, and nuclear power. Clear synergies exist between CHP and most other technologies that dominate the energy and environmental policy dialogue in the country today. As the Nation transforms how it produces, transports, and uses the many forms of energy, it must seize the clear opportunity afforded by CHP in terms of climate change, economic competitiveness, energy security, and infrastructure modernization. The energy efficiency benefits of CHP offer significant, realistic solutions to near- and long-term energy issues facing the Nation. With growing demand for energy, tight supply options, and increasing environmental constraints, extracting the maximum output from primary fuel sources through efficiency is critical to sustained economic development and environmental stewardship. Investment in CHP would stimulate the creation of new 'green-collar' jobs, modernize aging energy infrastructure, and protect and enhance the competitiveness of US manufacturing industries. The complementary roles of energy efficiency, renewable energy, and responsible use of traditional energy supplies must be recognized. CHP's proven performance and potential for wider use are evidence of its near-term applicability and, with technological improvements and further elimination of market barriers, of its longer term promise to address the country's most important energy and environmental needs. A strategic approach is needed to encourage CHP where it can be applied today and address the regulatory and technical challenges preventing its long-term viability. Experience in the United States and other countries shows that a balanced set of policies, incentives, business models, and investments can stimulate sustained CHP growth and allow all stakeholders to reap its many well-documented benefits

Statistical Inference for Valued-Edge Networks: Generalized Exponential Random Graph Models

Across the sciences, the statistical analysis of networks is central to the production of knowledge on relational phenomena. Because of their ability to model the structural generation of networks, exponential random graph models are a ubiquitous means of analysis. However, they are limited by an inability to model networks with valued edges. We solve this problem by introducing a class of generalized exponential random graph models capable of modeling networks whose edges are valued, thus greatly expanding the scope of networks applied researchers can subject to statistical analysis

Silent progression in disease activity-free relapsing multiple sclerosis.

ObjectiveRates of worsening and evolution to secondary progressive multiple sclerosis (MS) may be substantially lower in actively treated patients compared to natural history studies from the pretreatment era. Nonetheless, in our recently reported prospective cohort, more than half of patients with relapsing MS accumulated significant new disability by the 10th year of follow-up. Notably, "no evidence of disease activity" at 2 years did not predict long-term stability. Here, we determined to what extent clinical relapses and radiographic evidence of disease activity contribute to long-term disability accumulation.MethodsDisability progression was defined as an increase in Expanded Disability Status Scale (EDSS) of 1.5, 1.0, or 0.5 (or greater) from baseline EDSS = 0, 1.0-5.0, and 5.5 or higher, respectively, assessed from baseline to year 5 (±1 year) and sustained to year 10 (±1 year). Longitudinal analysis of relative brain volume loss used a linear mixed model with sex, age, disease duration, and HLA-DRB1*15:01 as covariates.ResultsRelapses were associated with a transient increase in disability over 1-year intervals (p = 0.012) but not with confirmed disability progression (p = 0.551). Relative brain volume declined at a greater rate among individuals with disability progression compared to those who remained stable (p < 0.05).InterpretationLong-term worsening is common in relapsing MS patients, is largely independent of relapse activity, and is associated with accelerated brain atrophy. We propose the term silent progression to describe the insidious disability that accrues in many patients who satisfy traditional criteria for relapsing-remitting MS. Ann Neurol 2019;85:653-666