Precautionary labelling of foods for allergen content: are we ready for a global framework?

© 2014 Allen et al.; licensee BioMed Central Ltd.Food allergy appears to be on the rise with the current mainstay of treatment centred on allergen avoidance. Mandatory allergen labelling has improved the safety of food for allergic consumers. However an additional form of voluntary labelling (termed precautionary allergen labelling) has evolved on a wide range of packaged goods, in a bid by manufacturers to minimise risk to customers, and the negative impact on business that might result from exposure to trace amounts of food allergen present during cross-contamination during production. This has resulted in near ubiquitous utilisation of a multitude of different precautionary allergen labels with subsequent confusion amongst many consumers as to their significance. The global nature of food production and manufacturing makes harmonisation of allergen labelling regulations across the world a matter of increasing importance. Addressing inconsistencies across countries with regards to labelling legislation, as well as improvement or even banning of precautionary allergy labelling are both likely to be significant steps forward in improved food safety for allergic families. This article outlines the current status of allergen labelling legislation around the world and reviews the value of current existing precautionary allergen labelling for the allergic consumer. We strongly urge for an international framework to be considered to help roadmap a solution to the weaknesses of the current systems, and discuss the role of legislation in facilitating this

Treatment in the STAMPEDE era for castrate resistant prostate cancer in the UK: ongoing challenges and underappreciated clinical problems.

This study aimed to explore the opinions of healthcare professionals regarding the management of men with advanced prostate cancer with particular emphasis on treatment timing and sequencing; treatment adverse-effects and exercise a supportive therapy. Semi-structured interviews with a purposively selected group of healthcare professionals involved in prostate cancer care within the NHS, conducted over the phone or face to face. A total of 37 healthcare professionals participated in the interviews including urologists, clinical oncologists, medical oncologists, clinical nurse specialists, general practitioners, physiotherapists, exercise specialists, service managers, clinical commissioners and primary care physicians. The availability of newer treatments for advanced prostate cancer as well as results from the STAMPEDE and CHAARTED trials has resulted in new challenges for patients and HCPs. This includes the impact of an increased workload on oncologists, a potential lack of clinical continuity between urology and oncology and uncertainties regarding optimal selection, timing and sequencing of chemotherapy and second-line treatment. Fitness for treatment in advanced prostate cancer populations remains a significant barrier to accessing therapies for patients with a poor performance status. Among this, muscle wastage can significantly affect performance status and consequentially compromise cancer therapy. Exercise was regarded as a potential therapy to mitigate the adverse-effects of treatment including the prevention or reduction in muscle wastage. There is a lack of data guiding clinicians in this post STAMPEDE and CHAARTED era, work is needed to reassess and optimize the prostate cancer care pathway as it evolves. Exercise should be explored as a therapeutic option to mitigate the effects of long term ADT. Further study from a wider cohort of both prostate cancer care specialists and patients will aid in establishing a highly functioning pathway with optimal individualised care. Sustained exercise TrAining for Men wIth prostate caNcer on Androgen deprivation: the STAMINA programme (RP-DG-1213-10,010). REC Reference: 15/SW/0260 IRAS Project ID: 178340 Hospital ID: STH 18391 approved on 24/08/2015

Remote interventions to improve exercise behaviour in sedentary people living with and beyond cancer: a systematic review and meta-analysis

Abstract: Background: The COVID-19 pandemic has forced many cancer services to consider a transition to a remote format of delivery that is largely untested. Accordingly, we sought to perform a systematic review of the effects of remotely delivered interventions to improve exercise behaviour in sedentary adults living with and beyond cancer. Methods: Eligible studies were randomised controlled trials comparing a remotely delivered exercise intervention to a usual care comparison in sedentary people over 18 years old with a primary cancer diagnosis. Nine electronic databases were searched from inception to November 2020. Results: The review included three trials, totalling 186 participants. Two of the included trials incorporated prescriptions that meet current aerobic exercise recommendations, one of which also meets the guidelines for resistance exercise. No trials reported an intervention adherence of 75% or more for a set prescription that meets current exercise guidelines. Conclusion: There is little evidence suggesting that remote exercise interventions promote exercise behaviours or improve physical function in sedentary adults living with and beyond cancer. The development and evaluation of novel remote exercise interventions is needed to establish their usefulness for clinical practice. Given the social response to the COVID-19 pandemic, further research in this area is urgently needed

Uso potencial de extractos de Larrea divaricata con bajo contenido de NDGA como antioxidantes en comidas

Larrea divaricata Cav. is widely distributed in Argentina. Aqueous extract, of its leaves, has documented antitumoral and immunomodulatory activities. In this study, the antioxidant activity of aqueous extract and a component, nordihydroguaiaretic acid was determined and compared using different assays. Both the aqueous extract and nordihydroguaiaretic acid exhibited antioxidant activity. However, results show that it is very likely that compounds other than nordihydroguaiaretic acid could be involved in the antioxidant activity of the extract. Since nordihydroguaiaretic acid is nephrotoxic and hepatotoxic agent, it is important to direct efforts toward the potential use of low-nordihydroguaiaretic acid L. divaricata extracts as antioxidant in foods.Larrea divaricata Cav. está ampliamente distribuida en la Argentina. Se han documentado actividades antitumorales e inmunomoduladoras de los extractos acuosos de sus hojas. En este estudio, la actividad antioxidante del extracto acuoso y un componente, el ácido nordihidroguayarético, se determinaron y compararon mediante diferentes ensayos. Tanto el extracto acuoso como el ácido nordihidroguayarético mostraron actividad antioxidante. Sin embargo, los resultados muestran que es muy probable que otros compuestos diferentes al ácido nordihidroguayarético pudieran estar involucrados en la actividad antioxidante de los extractos. Dado que el ácido nordihidroguayarético es un agente nefrotóxico y hepatotóxico, es importante dirigir los esfuerzos hacia el uso potencial de extractos de L. divaricata con bajas cantidades de ácido nordihidroguayarético como antioxidantes en alimentos

Interventions for promoting habitual exercise in people living with and beyond cancer

Background: This is an updated version of the original Cochrane Review published in the Cochrane Liibrary 2013, Issue 9. Despite good evidence for the health benefits of regular exercise for people living with or beyond cancer, understanding how to promote sustainable exercise behaviour change in sedentary cancer survivors, particularly over the long term, is not as well understood. A large majority of people living with or recovering from cancer do not meet current exercise recommendations. Hence, reviewing the evidence on how to promote and sustain exercise behaviour is important for understanding the most effective strategies to ensure benefit in the patient population and identify research gaps. Objectives: To assess the effects of interventions designed to promote exercise behaviour in sedentary people living with and beyond cancer and to address the following secondary questions: Which interventions are most effective in improving aerobic fitness and skeletal muscle strength and endurance? Which interventions are most effective in improving exercise behaviour amongst patients with different cancers? Which interventions are most likely to promote long-term (12 months or longer) exercise behaviour? What frequency of contact with exercise professionals and/or healthcare professionals is associated with increased exercise behaviour? What theoretical basis is most often associated with better behavioural outcomes? What behaviour change techniques (BCTs) are most often associated with increased exercise behaviour? What adverse effects are attributed to different exercise interventions? Search methods: We used standard methodological procedures expected by Cochrane. We updated our 2013 Cochrane systematic review by updating the searches of the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, Embase, AMED, CINAHL, PsycLIT/PsycINFO, SportDiscus and PEDro up to May 2018. We also searched the grey literature, trial registries, wrote to leading experts in the field and searched reference lists of included studies and other related recent systematic reviews. Selection criteria: We included only randomised controlled trials (RCTs) that compared an exercise intervention with usual care or 'waiting list' control in sedentary people over the age of 18 with a homogenous primary cancer diagnosis. Data collection and analysis: In the update, review authors independently screened all titles and abstracts to identify studies that might meet the inclusion criteria, or that could not be safely excluded without assessment of the full text (e.g. when no abstract is available). We extracted data from all eligible papers with at least two members of the author team working independently (RT, LS and RG). We coded BCTs according to the CALO-RE taxonomy. Risk of bias was assessed using the Cochrane's tool for assessing risk of bias. When possible, and if appropriate, we performed a fixed-effect meta-analysis of study outcomes. If statistical heterogeneity was noted, a meta-analysis was performed using a random-effects model. For continuous outcomes (e.g. cardiorespiratory fitness), we extracted the final value, the standard deviation (SD) of the outcome of interest and the number of participants assessed at follow-up in each treatment arm, to estimate the standardised mean difference (SMD) between treatment arms. SMD was used, as investigators used heterogeneous methods to assess individual outcomes. If a meta-analysis was not possible or was not appropriate, we narratively synthesised studies. The quality of the evidence was assessed using the GRADE approach with the GRADE profiler. Main results: We included 23 studies in this review, involving a total of 1372 participants (an addition of 10 studies, 724 participants from the original review); 227 full texts were screened in the update and 377 full texts were screened in the original review leaving 35 publications from a total of 23 unique studies included in the review. We planned to include all cancers, but only studies involving breast, prostate, colorectal and lung cancer met the inclusion criteria. Thirteen studies incorporated a target level of exercise that could meet current recommendations for moderate-intensity aerobic exercise (i.e.150 minutes per week); or resistance exercise (i.e. strength training exercises at least two days per week). Adherence to exercise interventions, which is crucial for understanding treatment dose, is still reported inconsistently. Eight studies reported intervention adherence of 75% or greater to an exercise prescription that met current guidelines. These studies all included a component of supervision: in our analysis of BCTs we designated these studies as 'Tier 1 trials'. Six studies reported intervention adherence of 75% or greater to an aerobic exercise goal that was less than the current guideline recommendations: in our analysis of BCTs we designated these studies as 'Tier 2 trials.' A hierarchy of BCTs was developed for Tier 1 and Tier 2 trials, with programme goal setting, setting of graded tasks and instruction of how to perform behaviour being amongst the most frequent BCTs. Despite the uncertainty surrounding adherence in some of the included studies, interventions resulted in improvements in aerobic exercise tolerance at eight to 12 weeks (SMD 0.54, 95% CI 0.37 to 0.70; 604 participants, 10 studies; low-quality evidence) versus usual care. At six months, aerobic exercise tolerance was also improved (SMD 0.56, 95% CI 0.39 to 0.72; 591 participants; 7 studies; low-quality evidence). Authors' conclusions: Since the last version of this review, none of the new relevant studies have provided additional information to change the conclusions. We have found some improved understanding of how to encourage previously inactive cancer survivors to achieve international physical activity guidelines. Goal setting, setting of graded tasks and instruction of how to perform behaviour, feature in interventions that meet recommendations targets and report adherence of 75% or more. However, long-term follow-up data are still limited, and the majority of studies are in white women with breast cancer. There are still a considerable number of published studies with numerous and varied issues related to high risk of bias and poor reporting standards. Additionally, the meta-analyses were often graded as consisting of low- to very low-certainty evidence. A very small number of serious adverse effects were reported amongst the studies, providing reassurance exercise is safe for this population. © 2018 The Cochrane Collaboration

Delayed triggering of radio Active Galactic Nuclei in gas-rich minor mergers in the local Universe

This article has been accepted for publication in Monthly Notices of the Royal Astronomical Society © : 2016 [S. S. Shabala, a. Deller, S. Kaviraj, E. Middelberg, R. J. Turner, Y. S. Ting, J. R. Allison, T. A Davis, 'Delayed triggering of radio active galactic nucle in gas-rich minor mergers in the local Universe', MNRAS (2016) 464(4): 4706-4720]. The final, published version is available online via doi: https://doi.org/10.1093/mnras/stw2536 Published by Oxford University Press on behalf of the Royal Astronomical Society. All rights reserved.We examine the processes triggering star formation and Active Galactic Nucleus (AGN) activity in a sample of 25 low redshift ($z 10^7$ K) brightness temperature required for an mJIVE-20 detection allows us to unambiguously identify the radio AGN in our sample. We find three such objects. Our VLBI AGN identifications are classified as Seyferts or LINERs in narrow line optical diagnostic plots; mid-infrared colours of our targets and the comparison of H$\alpha$ star formation rates with integrated radio luminosity are also consistent with the VLBI identifications. We reconstruct star formation histories in our galaxies using optical and UV photometry, and find that these radio AGN are not triggered promptly in the merger process, consistent with previous findings for non-VLBI samples of radio AGN. This delay can significantly limit the efficiency of feedback by radio AGN triggered in galaxy mergers. We find that radio AGN hosts have lower star formation rates than non-AGN radio-selected galaxies at the same starburst age. Conventional and VLBI radio imaging shows these AGN to be compact on arcsecond scales. Our modeling suggests that the actual sizes of AGN-inflated radio lobes may be much larger than this, but these are too faint to be detected in existing observations. Deep radio imaging is required to map out the true extent of the AGN, and to determine whether the low star formation rates in radio AGN hosts are a result of the special conditions required for radio jet triggering, or the effect of AGN feedback.Peer reviewe

Cambios celulares reversibles observados in vivo durante la desecación y recuperación: Tolerancia a la desecación del helecho película de resurrección Hymenophyllum dentatum Cav.

The present work explores in vivo physiological, morphological and chemical features during full hydration, desiccation and rehydration of the filmy fern Hymenophyllum dentatum with two main objectives: 1) to get further insight about the mechanisms underlying its desiccation tolerance, and 2) to understand how this plant manages mechanical stress induced by water loss and recovery. With these purposes, physiological (relative water content and Fv/Fm chlorophyll fluorescence parameter), morphological (Confocal Laser Scanning Microscopy and 3D reconstruction) and chemical (FTIR microspectroscopy) data were obtained and compared between fully hydrated, desiccated and rehydrated tissues of H. dentatum. Remarkable changes in cell architecture and chemical composition were observed in vivo in desiccated leaves. Cells were smaller, showed a collapsed general appearance, and were delimitated by apparently folded cell walls. Marked changes in chloroplasts location and decrease in the number of active chloroplasts were also evidenced. Chemical experiments showed that changes in the secondary structure of proteins and in the polysaccharide composition of the cell wall occur in desiccated cells. All changes were rapidly reversed upon rehydration. This study shows that H. dentatum presents an extreme case of desiccation tolerance, able to withdraw severe, rapid and consecutive dehydration/rehydration induced stress by the function of constitutive systems of protection and reparation, in which cell wall folding plays a relevant role as a protective system against mechanical and oxidative stress. Besides, H. dentatum is proposed as an excellent plant model for the study of dissection tolerance such as one cell layer fern, auto-fluorescence of cellular compartments, and simple long term storage under laboratory conditions, among others.El presente trabajo muestra una exploración in vivo de los rasgos fisiológicos, morfológicos y químicos que caracterizan a los estados de hidratación completa, desecación y rehidratación del helecho película Hymenophyllum dentatum, que persigue 2 objetivos principales: 1) Adquirir conocimientos sobre los mecanismos que subyacen a la tolerancia a la desecación, y 2) entender cómo estas plantas manejan el estrés mecánico inducido por la pérdida y recuperación de agua. Con estos propósitos se obtuvo datos fisiológicos (contenido relativo de agua y parámetro de fluorescencia de clorofila Fv/Fm), morfológicos (microscopía confocal de escaneo laser en 3 D) y químicos (microespectroscopía FT-IR), en los tejidos de H. dentatum en los estados completamente hidratado, desecado y rehidratado. Notorios cambios en la arquitectura celular y la composición química fueron observados in vivo en las hojas desecadas. Las células eran de menos tamaño, presentaron una apariencia general colapsada, y delimitadas por una pared celular con apariencia plegada. También se evidenciaron marcados cambios en la localización y una disminución en el número de cloroplastos activos durante la desecación. Los ensayos químicos mostraron que en las células en desecación ocurren cambios en la estructura secundaria de una proteína citoplasmática muy abundante y en los polisacáridos que componen la pared celular. Todos estos cambios revierten al estado inicial tras la rehidratación de los tejidos. Este estudio muestra que H. dentatum es un caso extremo de tolerancia a la desecación, capaz de sobreponerse tras el estrés inducido por ciclos de alternancia entre desecación y rehidratación, mediante el funcionamiento de sistemas constitutivos de protección y reparación, entre los cuales el plegamiento de la pared celular parece jugar un rol clave como protector contra el daño mecánico y el estrés oxidativo. Además, H. dentatum es propuesto como una excelente planta modelo para el estudio de la tolerancia a la desecación porque posee características como tener hojas constituidas por una sola capa de células, poseer estructuras internas auto-fluorescentes, resistencia en condiciones simples de almacenamiento en el laboratorio, entre otras

Towards implementing exercise into the prostate cancer care pathway: development of a theory and evidence-based intervention to train community-based exercise professionals to support change in patient exercise behaviour (The STAMINA trial)

Abstract Background The National Institute for Health and Care Excellence (NICE) recommend that men on androgen deprivation therapy (ADT) for prostate cancer should receive supervised exercise to manage the side-effects of treatment. However, these recommendations are rarely implemented into practice. Community-based exercise professionals (CBEPs) represent an important target group to deliver the recommendations nationally, yet their standard training does not address the core competencies required to work with clinical populations, highlighting a need for further professional training. This paper describes the development of a training package to support CBEPs to deliver NICE recommendations. Methods Development of the intervention was guided by the Medical Research Council guidance for complex interventions and the Behaviour Change Wheel. In step one, target behaviours, together with their barriers and facilitators were identified from a literature review and focus groups with CBEPs (n = 22) and men on androgen deprivation therapy (n = 26). Focus group outputs were mapped onto the Theoretical Domains Framework (TDF) to identify theoretical constructs for change. In step two, behaviour change techniques and their mode of delivery were selected based on psychological theories and evidence to inform intervention content. In step three, the intervention was refined following delivery and subsequent feedback from intervention recipients and stakeholders. Results Six modifiable CBEPs target behaviours were identified to support the delivery of the NICE recommendations. Nine domains of the TDF were identified as key determinants of change, including: improving knowledge and skills and changing beliefs about consequences. To target the domains, we included 20 BCTs across 8 training modules and took a blended learning approach to accommodate different learning styles and preferences. Following test delivery to 11 CBEPs and feedback from 28 stakeholders, the training package was refined. Conclusion Established intervention development approaches provided a structured and transparent guide to intervention development. A training package for CBEPs was developed and should increase trust amongst patients and health care professionals when implementing exercise into prostate cancer care. Furthermore, if proven effective, the development and approach taken may provide a blueprint for replication in other clinical populations where exercise has proven efficacy but is insufficiently implemented

Strategies adopted by men to deal with uncertainty and anxiety when following an active surveillance/monitoring protocol for localised prostate cancer and implications for care: a longitudinal qualitative study embedded within the ProtecT trial.

OBJECTIVES: Active surveillance (AS) enables men with low risk, localised prostate cancer (PCa) to avoid radical treatment unless progression occurs; lack of reliable AS protocols to determine progression leaves uncertainties for men and clinicians. This study investigated men's strategies for coping with the uncertainties of active monitoring (AM, a surveillance strategy within the Prostate testing for cancer and Treatment, ProtecT trial) over the longer term and implications for optimising supportive care. DESIGN: Longitudinal serial in-depth qualitative interviews every 2-3 years for a median 7 (range 6-14) years following diagnosis. SETTING: Four centres within the UK Protect trial. PARTICIPANTS: Purposive sample of 20 men with localised PCa: median age at diagnosis 64 years (range 52-68); 15 (75%) had low-risk PCa; 12 randomly allocated to, 8 choosing AM. Eleven men continued with AM throughout the study period (median 7 years). Nine received radical treatment after a median 4 years (range 0.8-13.8 years). INTERVENTION: AM: 3-monthly serum prostate-specific antigen (PSA)-level assessment (year 1), 6-12 monthly thereafter; increase in PSA ≥50% during previous 12 months or patient/clinician concern triggered review. MAIN OUTCOMES: Thematic analysis of 73 interviews identified strategies to accommodate uncertainty and anxiety of living with untreated cancer; implications for patient care. RESULTS: Men sought clarity, control or reassurance, with contextual factors mediating individual responses. Trust in the clinical team was critical for men in balancing anxiety and facilitating successful management change/continued monitoring. Only men from ProtecT were included; men outside ProtecT may have different experiences. CONCLUSION: Men looked to clinicians for clarity, control and reassurance. Where provided, men felt comfortable continuing AM or having radical treatments when indicated. Clinicians build patient trust by clearly describing uncertainties, allowing patients control wherever possible and being aware of how context influences individual responses. Insights indicate need for supportive services to build trust and patient engagement over the long term. TRIAL REGISTRATION NUMBER: ISRCTN20141297; Pre-results