Research needs for optimising wastewater-based epidemiology monitoring for public health protection

Wastewater-based epidemiology (WBE) is an unobtrusive method used to observe patterns in illicit drug use, poliovirus, and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The pandemic and need for surveillance measures have led to the rapid acceleration of WBE research and development globally. With the infrastructure available to monitor SARS-CoV-2 from wastewater in 58 countries globally, there is potential to expand targets and applications for public health protection, such as other viral pathogens, antimicrobial resistance (AMR), pharmaceutical consumption, or exposure to chemical pollutants. Some applications have been explored in academic research but are not used to inform public health decision-making. We reflect on the current knowledge of WBE for these applications and identify barriers and opportunities for expanding beyond SARS-CoV-2. This paper critically reviews the applications of WBE for public health and identifies the important research gaps for WBE to be a useful tool in public health. It considers possible uses for pathogenic viruses, AMR, and chemicals. It summarises the current evidence on the following: (1) the presence of markers in stool and urine; (2) environmental factors influencing persistence of markers in wastewater; (3) methods for sample collection and storage; (4) prospective methods for detection and quantification; (5) reducing uncertainties; and (6) further considerations for public health use

Manipulating constraints to train decision making in Rugby Union

This paper focuses on the paradoxical relationship between game unpredictability and the certainty of players' actions in team ball sports. Our research on this relationship leads us to suggest a method for training decision making, which we exemplify in the team sport of Rugby Union. The training methodology is based on application of theoretical insights from ecological psychology, complex dynamical systems and the constraints-led approach. The paper starts with a critical overview of traditional approaches to studying decision making in sport. Next we describe the sport of Rugby Union to exemplify a complex dynamical system, and explain how that conceptualisation captures the interactions of players within that performance context. We conclude our analysis by describing how to manipulate task constraints to improve decision-making performance, as players search for an appropriate blend of stability and variability in their actions. In the final part of the paper, we suggest some methods to train decision making based on four stages: i) identifying the problem; ii) setting out a strategy to solve it; iii) creating an action model; and iv) building a decision-making exercise. The main conclusion from our work for coaches and sports scientists is that decision making should be improved through training methods that provide an accurate balance between stability of actions, which gives structure to the players' performance, and variability, which allows them to cope with the uncertainty of situational constraints, such as the behaviour of specific opponents

Muscle size, strength, and physical function in response to augmented calorie delivery: A TARGET sub-study.

Purpose Augmented calories may attenuate muscle loss experienced in critical illness. This exploratory sub-study assessed the effect of augmented calorie delivery on muscle mass, strength, and function. Materials and methods Patients in The Augmented versus Routine approach to Giving Energy Trial (TARGET) randomised to 1.5 kcal/ml or 1.0 kcal/ml enteral formulae at a single-centre were included. Ultrasound-derived muscle layer thickness (MLT) at quadriceps, forearm and mid-upper arm, and handgrip strength, were measured weekly from baseline to hospital discharge, and 3- and 6-months. Physical function was assessed at 3- and 6-months using the 'get up and go' and 6-min walk tests. Data are mean ± SD. Results Eighty patients were recruited (1.5 kcal: n = 38, 58 ± 14y, 60%M, APACHE II 20 ± 7; 1.0 kcal: n = 42, 54 ± 18y, 66%M, APACHE II 22 ± 10). The 1.5 kcal/ml group received more calories with no difference in quadriceps MLT at any timepoint including ICU discharge (primary outcome) (2.90 ± 1.27 vs 2.39 ± 1.06 cm; P = 0.141). Relationships were similar for all MLT measures, handgrip strength, and 6-min walk test. Patients in the 1.5 kcal/ml group had improved 'get up and go' test at 3-months (6.66 ± 1.33 vs. 9.11 ± 2.94 s; P = 0.014). Conclusion Augmented calorie delivery may not attenuate muscle loss or recovery of strength or function 6-months post-ICU, but this requires exploration in a larger trial.Lee-anne S. Chapple, Matthew J. Summers, Luke M.Weinel, Kylie Lange, Woo Han Yang, Adam M. Deane, Marianne J. Chapman, The TARGET Investigators for the Australia and New Zealand Intensive Care Society Clinical Trials Grou