• Quality Control Systems of Gum Arabic in Sudan

      Al-Assaf, Saphwan; Eldigair, Hashim, Y. (University of Chester, 2018-11)
      Gum arabic is the oldest tree gum exudate, and has been in use since 4000 BC. Currently, it is used as an emulsifier (E414) in a number of processes, such as producing sweets and soft drinks. This study examines local practices such as tapping, collecting, transporting, sorting, and storing in various production areas in Sudan. Furthermore, it also investigates statistical differences in the key variables such as moisture content, optical rotation, ash content, viscosity, pH, colour Gardner index, colour Lovibond and tannin content in various production regions in Sudan during four seasons, namely 2013, 2014, 2015 and 2016. This study offers originality as the first investigation to combine labour practices related to quality control systems in a Sudanese context, using both primary and secondary data. Primary data were obtained from survey questionnaires (n=413 out of 800) distributed, giving a response rate of 52%, using chain-referral sampling among gum arabic farmers, managers, supervisors, and stakeholders. In addition to the questionnaires, open-ended (interview) questions were distributed to stakeholders and experts, by employing maximum variation sampling (n=15 out of 20 questions distributed, providing a response rate of 75%). Other primary data, namely, analytical and experimental data, were obtained from Nopec Quality Control Laboratory in Khartoum, and from the Hydrocolloids Research Centre at the University of Chester. Secondary data (national production) was obtained from the Sudan Customs Corporation via the Gum Arabic Board in Sudan. The findings of the survey questionnaires generally reveal that most workers tend to (i) work for relatively long time in the gum arabic industry, (ii) are knowledgeable about quality control systems, and (iii) aware about the best methods for maintaining product quality, collecting and storing gum arabic (r=-0.821). Specifically, the strongest correlation coefficient (p=0.001) were found between the worker’s age and the duration of working in the gum arabic industry (r=0.655). That is, the older respondents tend to be male while younger respondents tend to be female (r=-0.623). In addition, the majority of respondents (r=0.476) were knowledgeable about the production areas of gum arabic in Sudan as well as the location of the main auction market in Al Obeid. The findings from expert interviews indicate that there are both facilitative and hindrance factors that affect gum arabic development; these are related to infrastructure, technology, socio-economy, and relevant institution. The hindrance factors are, inter alia, the existence of relatively higher taxes, inefficient transportation, outdated technology and inconsistent quality control systems used by various gum arabic processing companies. Conversely, there are also facilitative factors such as financial assistance (the sheilla system) for farmers from banks, regular training, and methodical improvement of tapping through the use of modernised tools. The most significant factor is the agreement by all interviewees that better quality control systems should be a key to the development of this product therefore, allowing the suppliers to offer a quality product rather than a commodity. The results of secondary data reveal an increase in export trends from 2012 to 2018, indicating continuous growth in the industry and in particular for Acacia seyal compared to the previously held standard of Acacia Senegal. Finally, the findings of the analytical data reveal that key variables while differ across the various production season, the quality of the material from a given production area does not differ significantly. This is the major finding of this study whereby using reliable supply chain, traceability system and quality control measurements it would be possible to supply gum arabic with certain characteristics suitable for a given application. In conclusion, the findings are useful addition to our knowledge and potentially of commercial impact.
    • Acculturation and Food Intake Among Ghanaian Migrants in Europe: Findings From the RODAM Study

      Osei-Kwasi, Hibbah Araba; email: h.a.osei-kwasi@sheffield.ac.uk; Boateng, Daniel; Danquah, Ina; Holdsworth, Michelle; Mejean, Caroline; Terragni, Laura; Powell, Katie; Schulze, Matthias B.; Owusu-Dabo, Ellis; Meeks, Karlijn; orcid: 0000-0003-3032-405X; et al.
      Abstract Objective This study examined the role of migration and acculturation in the diet of Ghanaian migrants in Europe by (1) comparing food intake of Ghanaian migrants in Europe with that of Ghanaians living in Ghana and (2) assessing the association between acculturation and food intake. Design Data from the cross-sectional multicenter study Research on Obesity and Diabetes among African Migrants were used. Food intake was assessed using a Ghana-specific food propensity questionnaire (134 items and 14 food groups); foods were grouped based on a model of dietary change proposed by Koctürk-Runefors. Setting Ghana, London, Amsterdam, and Berlin. Participants A total of 4,534 Ghanaian adults living in Ghana and Europe, with complete dietary data. Of these, 1,773 Ghanaian migrants had complete acculturation data. Main Outcome Measure Food intake (the weighted intake frequency per week of food categories). Analysis Linear regression. Results Food intake differed between Ghanaians living in Ghana and Europe. Among Ghanaian migrants in Europe, there were inconsistent and small associations between acculturation and food intake, except for ethnic identity, which was consistently associated with intake only of traditional staples. Conclusions and Implications Findings indicate that migration is associated with dietary changes that cannot be fully explained by ethnic, cultural, and social acculturation. The study provides limited support to the differential changes in diet suggested by the Koctürk-Runefors’ model of dietary change.
    • Development, Digestibility and Oxidation Properties of LC3PUFA Nanoemulsion and Its Effects on Sensory Profile of Food

      Zhou, QiQian (University of Chester, 2019-02)
      The long chain omega-3 polyunsaturated fatty acids (LC3PUFA) in human diets are mainly derived from oily fish and fish oil based supplements. Currently, the consumption of oily fish in the UK is far below the recommended level. LC3PUFA's non-fish sources such as algal oil with DHA (docosahexaenoic acid) are particularly important for vegetarians, non-fish eaters, and pregnant women. In previous work, high DHA vegetative algal oil load 50% w/w was successfully used to develop an oil-in-water nanoemulsion system suitable for functional food enrichment. The aims of this study included to investigate the effect of selected emulsifiers on oil-in-water nanoemulsions of algal oil prepared using ultrasonic technology. To improve the stability and digestibility of nanoemulsions within an In vitro digestion model. To examine the oxidation stability of nanoemulsions of algal oil and bulk algal oil with composition and droplet size changes during a 5 weeks storage trial at a temperature of 4 °C, 20 °C and 40 °C respectively. To evaluate sensory properties and consumer acceptability of food products with the incorporation of resulted nanoemulsion and find out possible relationship between the sensory profile of foods and the characteristics of added nanoemulsion. Nanoemulsion of LC3PUFA algal oil was developed with selected 6% w/w emulsifiers, including Lecithin (LN), Tween 40 (TN), Tween 60, equal ratio of Tween 40 and lecithin (LTN), 50% w/w Algal oil and 44%w/w water using a homogenizer and ultrasound processor. The results show that the nanoemulsion has been stabilised with selected emulsifiers (LN, TN & LTN) and the smallest droplet size of nanoemulsion was obtained using the combination of lecithin and Tween 40 at ratio 50:50. The In vitro digestion experiments were conducted with a model of fed state gastric and duodenal digestion using method of Lin et al (2014). The results show that the omega-3 oil nanoemulsion (LE/TW 50:50) were stable over 60 min in the gastric phase, in contrast omega-3 nanoemulsion (LE 100%) was destabilised at the gastric phase in 60 min, in which the droplet size diameter was significantly larger than at the beginning of gastric phase (P ≤ 0.05). The droplet size, fatty composition and oxidised compounds were measured to compare bulk algal oil and nanoemulsions stabilised with lecithin (LN) and Tween 40 (TN) solely and in combination (LTN) over a storage period of 5 weeks at temperatures of 4, 20 and 40°C. The results show the droplet size of nanoemulsions had no significant changes for samples stored at tested temperatures over 5 weeks storage. There were no significant differences in DHA composition within the weeks and temperatures used. For the GCHS analysed results, the increase in temperature to 40 ºC and storage time had a significant effect on the development of propanal for all samples (P≤0.05). Nanoemulsions prepared with lecithin alone had significantly higher development of propanal in week 1 at both 40 ºC and 20 ºC (P≤0.05). Lecithin (sole and combination with Tween 40) had more significant increases in oxidised volatiles at 40°C, which may be due to the instability of linoleic acid found in lecithin molecules which located in the outer layer of the oil droplets. There were no significant increase in oxidised compounds from the beginning to the end of storage for all tested samples stored at 4 °C. The sensory testing was also conducted on white sauce incorporated with omega-3 nanoemulsions with selected emulsifiers and bulk algal oil. The results show that the sensory attributes and overall acceptability of foods enriched with omega-3 nanoemulsion were statistically significantly lower than that of control sample (P≤ 0.05). Overall, the smallest droplet size of nanoemulsion was achieved with combination of lecithin and Tween 40 at a ratio of 50:50 by using ultrasonic processor. The stability and digestibility of nanoemulsion with the combination of lecithin and Tween 40 was improved in an In vitro digestion approach. A storage period of 5 weeks and temperature have no significant effect on the droplet size of tested nanoemulsion samples. However, there is a significant increase of the oxidised volatiles at 40 °C for all samples. Sensory testing show the white sauce with nanoemulsion has a stronger fishy taste and less overall liking than with bulk oil, indicating the smaller drop size is more ready to spread and reach the sensors of the mouth.
    • The interaction between the physical and mental loads associated with actual and simulated rugby league performance

      Highton, Jamie; Twist, Craig; Mullen, Thomas (University of Chester, 2019-09)
      The aim of the current thesis was to develop knowledge of the ‘loads’ associated with rugby league match-play, with a particular focus on the effects of altered mental loads before and during exercise indicative of a rugby league match. Chapter 3 examined the test-retest reliability of movement, physiological and perceptual measures during and after a novel rugby match simulation, where movement commands were more random than those typical of match simulations. The most reliable measure of external load during bouts of the simulation was relative distance (typical error [TE] and coefficient of variation [CV%] = 1.5-1.6 m.min-1 and 1.4-1.5%, respectively), with all other movement characteristics possessing a CV% <5%. The most reliable measure of internal load, neuromuscular function and perceptual measures were for %HRmax during bout 1 (TE and CV% = 1.4-1.7% and 1-4-2.1%, respectively), MVC before (TE and CV% = 10.8-14.8 N·m and 3.8-4.6%, respectively), and average RPE (TE and CV% = 0.5-0.8 AU and 3.6-5.5%, respectively). The conclusion of this chapter was that randomisation of the movements during simulated activity to better reflect intermittent team sports has no detrimental effect on its reliability. Studies can therefore confidently examine alterations in several perceptual, neuromuscular, physiological and movement load measures related to rugby activity using stochastic movements. Chapter 4 examined the responses to a simulated rugby league protocol that was designed to include more random commands, and therefore require greater vigilance, than traditional team sport simulation protocols. The randomised simulation (RDM) was matched for the number and types of activity performed every 5.45 min in a control trial (CON), but included no repeated cycles of activity. The RDM trial was more mentally demanding than CON (Effect size (ES) = 0.56; ±0.57). Self-paced mean sprint performance increased in RDM (22.5 ± 1.4 vs. 21.6 ± 1.6 km∙h-1; ES = 0.50; ±0.45), which was accompanied by a higher RPE (14.3 ± 1.0 vs. 13.0 ± 1.4; ES = 0.87; ±0.54) and a greater number of errors in the Stroop Test (10.3 ± 2.5 vs. 9.3 ± 1.4 errors; ES = 0.65; ±0.67). MVC peak torque (CON = -48.4 ± 31.6 N.m, RDM = -39.6 ± 36.6 N.m) and voluntary activation (CON = -8.3 ± 4.8%, RDM = -6.0 ± 4.1%) was similarly reduced in both trials. Providing more random commands, requiring greater vigilance, can therefore alter performance and associated physiological, perceptual and cognitive responses to team sport simulations. Chapter 5 describes the subjective task load of elite rugby league match play using the NASA-TLX and examines their association with several contextual match factors, technical ii performance and external movement demands. Linear mixed modelling revealed that various combinations of contextual factors, technical performance and movement demands were associated with subjective task load (NASA-TLX). Greater number of tackles (η2 = 0.18), errors (η2 = 0.15) decelerations (η2 = 0.12), increased sprint distance (η2 = 0.13), losing matches (η2 = 0.36) and increased perception of effort (η2 = 0.27) lead to most likely – very likely increases in subjective total workload. These data provide a greater understanding of the internal load and their association with several contextual factors, technical performance and external movement demands during rugby league competition. The purpose of the final empirical chapter (Chapter 6) was to describe the effects of mental fatigue on simulated rugby league performance and to determine the effects of caffeine supplementation on simulated rugby league performance in the presence of mental fatigue. Completing a mentally demanding task increases participants’ subjective rating of mental fatigue (pre = 29 ± 25 AU; post = 55 ± 20 AU) immediately before completing a simulation protocol. Impairments in sprint speed (ES = -0.18; ±0.19), sprint to contact speed (ES = -0.20; ±0.27), high-intensity running (ES = -0.30; ±0.24), high metabolic power > 20 W·kg-1 (ES =-0.50; ±0.51) and time to complete a passing accuracy task (ES = 0.54; ±0.63) were observed after mental fatigue. Caffeine supplementation (5 mg.kg-1) attenuated several adverse effects of mental fatigue before exercise replicating the demands of rugby league match play, with increased sprint speed (ES = 0.40; ±0.18), high-intensity running (ES = 0.50; ±0.53), high metabolic power > 20 W·kg-1 (ES = 0.33; ±0.38) and decreased time to complete a passing accuracy test (ES =-0.70; ±0.45). Mental fatigue affected internal loads, external loads and skill performance during simulated rugby league match play that appear to be centrally regulated by a decreased motivation and increased perception of effort. However, a single dose of caffeine taken 60 min before performance can attenuate several of these negative effects. In summary, the current thesis highlights several interactions between the physical and mental loads associated with actual and simulated rugby league performance.
    • Preparation of Primary Rat Hepatocyte Spheroids Utilizing the Liquid-Overlay Technique.

      Kyffin, Jonathan A; Cox, Christopher R; Leedale, Joseph; Colley, Helen E; Murdoch, Craig; Mistry, Pratibha; Webb, Steven D; Sharma, Parveen (2019-09)
      Herein, we describe a protocol for the preparation and analysis of primary isolated rat hepatocytes in a 3D cell culture format described as spheroids. The hepatocyte cells spontaneously self-aggregate into spheroids without the need for synthetic extracellular matrices or hydrogels. Primary rat hepatocytes (PRHs) are a readily available source of primary differentiated liver cells and therefore conserve many of the required liver-specific functional markers, and elicit the natural in vivo phenotype when compared with common hepatic cells lines. We describe the liquid-overlay technique which provides an ultra-low attachment surface on which PRHs can be cultured as spheroids. © 2019 The Authors. Basic Protocol 1: Preparation of agarose-coated plates Basic Protocol 2: Primary rat hepatocyte isolation procedure Basic Protocol 3: Primary rat hepatocyte spheroid culture Basic Protocol 4: Immunofluorescent analysis of PRH spheroids. [Abstract copyright: © 2019 The Authors.]
    • To Infinity and Beyond: The Use of GPS Devices within the Football Codes

      Malone, James; Barrett, Stephen; Barnes, Chris; Twist, Craig; Drust, Barry; Liverpool Hope University; Hull City FC; CB Sports Performance; University of Chester; Liverpool John Moores University
      The quantification of external load through global positioning systems (GPS) is now commonplace across the different football codes. Despite this acceptance amongst sports science practitioners, confusion still remains around which are the most appropriate metrics to use when monitoring their athletes. In addition, the translation of the message between the data gathered and the athletes and coaches can often be lost. The aim of this commentary is to provide discussion and recommendations when using GPS for athlete monitoring.
    • “You Can’t Really Hug a Tiger”: Zookeepers and Their Bonds with Animals

      Birke, Lynda; Hosey, Geoff; Melfi, Vicky (Informa UK Limited, 2019-09-20)
    • Numerical simulation of non-Newtonian polymer film flow on a rotating spoked annulus

      Miah, Md Salim; orcid: 0000-0002-9722-8073; Hossain, Mohammad Sayeed; Ashraf, Muhammad Arif; Al-Assaf, Saphwan; McMillan, Alison (Wiley, 2017-03-03)
    • Individual, social, and environmental factors affecting salivary and fecal cortisol levels in captive pied tamarins (Saguinus bicolor)

      Price, Eluned E; Coleman, Robert; Ahsmann, J; Glendewar, G; Hunt, J; Smith, Tessa; Wormell, Dominic; University of Chester (Wiley, 2019-08-01)
      Pied tamarins (Saguinus bicolor) are endangered New World primates, and in captivity appear to be very susceptible to stress. We measured cortisol in 214 saliva samples from 36 tamarins and in 227 fecal samples from 27 tamarins, and investigated the effects of age, sex, pregnancy, rearing history, social status, weight, group composition, and enclosure type using generalized linear mixed models. There was no effect of age on either fecal or salivary cortisol levels. Female pied tamarins in late pregnancy had higher fecal cortisol levels than those in early pregnancy, or nonpregnant females, but there was no effect of pregnancy on salivary cortisol. Females had higher salivary cortisol levels than males, but there was no effect of rearing history. However, for fecal cortisol, there was an interaction between sex and rearing history. Hand‐reared tamarins overall had higher fecal cortisol levels, but while male parent‐reared tamarins had higher levels than females who were parent‐ reared, the reverse was true for hand‐reared individuals. There was a trend towards lower fecal cortisol levels in subordinate individuals, but no effect of status on salivary cortisol. Fecal but not salivary cortisol levels declined with increasing weight. We found little effect of group composition on cortisol levels in either saliva or feces, suggesting that as long as tamarins are housed socially, the nature of the group is of less importance. However, animals in off‐show enclosures had higher salivary and fecal cortisol levels than individuals housed on‐show. We suggest that large on‐show enclosures with permanent access to off‐exhibit areas may compensate for the effects of visitor disturbance, and a larger number of tamarins of the same species housed close together may explain the higher cortisol levels found in tamarins living in off‐show accommodation, but further research is needed.
    • Norwegian youngsters’ perceptions of physical education: Exploring the implications for mental health

      Røset, Linda; Green, Ken; Thurston, Miranda; University of Chester (Taylor & Francis, 2019-06-24)
      Improving young people’s mental health has become a priority for policy-makers in Norway as elsewhere. Although the evidence is limited, physical activity has been identified as having a role in mental health promotion with school physical education (PE) typically being presented as a suitable setting. Few studies, however, have explored young people’s perceptions and experiences of PE and the possible consequences for their mental health – the departure point for this paper. We approach this issue sociologically by focusing on the processes through which PE is enacted. Qualitative data were generated by 31 focus groups involving 148 youngsters from the 10th grade (15–16-year-olds) in eight secondary schools in Norway. The overarching theme to emerge was that PE was valued by the students for what it was not as much as what it was. The appeal of PE often lay in being different and a break from ‘normal’ school lessons and, at the same time, an opportunity for informal social interaction and strengthening social bonds. Enjoyment of PE – even among those with limited sporting competence – was understood as giving rise to cathartic benefits and an antidote to their increasingly academic, routinized and performance-oriented school lives. However, processes relating to the organization, delivery and assessment of lessons meant that these benefits were sometimes compromised for some young people. We conclude that as far as the mental health of young people is concerned, the best justificatory defence for PE becomes physical recreation as a solution to (academic) schooling rather than PE as education.
    • Analysis of physical demands during youth soccer match-play: Considerations of sampling method and epoch length

      Doncaster, Greg; Page, Richard; White, Paul; Svenson, Robert; Twist, Craig; Edge HIll University; Stoke City FC; University of Chester (Taylor and Francis, 2019)
      The purpose of this study was to examine the physical match profiles of professional soccer players using 3 and 5 min fixed and rolling averages as well as fixed 1 min averages, with considerations to training prescription. Twenty-nine, professional U23 soccer outfield players competed across 17 competitive matches during the 2017/18 season, equating to a total of 130 separate physical match profiles. Match activities were recorded using global positioning system (GPS) devices with integrated micro-electrical mechanical systems (MEMS), recording total distance (TD), high-speed running (HSR) and metabolic power (MP). For each individual match profile and variable, 1, 3 and 5 min peak, post-peak, and average values were calculated using fixed-time epochs (FIXED) and rolling averages (ROLL). Linear mixed models were employed to examine the differences in the dependent variables as a function of the method of measurement. Results revealed significantly higher peak values, for relative TD, relative HSR and relative MP when employing the ROLL sampling method, in comparison to the FIXED method, for both 3 min and 5 min epoch lengths. Analysis of epoch length revealed significantly higher peak values, across all positions, for relative TD, relative HSR and MP for 1 min epochs, in comparison to 3 min and 5 min epochs. The data offers a novel insight into the appropriate identification of physical demands during youth soccer match-play. Researchers and practitioners should consider the sampling method and epoch length when assessing the physical demands of competitive match-play, as well as when designing and prescribing sport-specific conditioning drills.
    • The importance of research applicability

      McLennan, Krista M.; University of Chester (The Humane Society Institute for Science and Policy, 2019-06)
      Marino & Merskin’s (2019) review contains key information about the complexity of sheep and their intelligence level, but lacks practical application. The key to making any long-term changes to sheep welfare at an industry level is by generating research that is practically relevant to the sector. The practical application of research should be considered at the design stage and in consultation with producers. Additionally, thought needs to be given to how the practical application of the research will be transferred to those people directly involved in animal care (e.g. producers, stockpersons, etc.). Focusing on the practical relevance and application of research at all stages of the process will foster changes to long-held beliefs and attitudes.
    • Arabinoxylans from rice bran and wheat immunomodulatory potentials: a review article

      Fadel, Abdulmannan; Plunkett, Andrew; Li, Weili; Ranneh, Yazan; Tessu Gyamfi, Vivian Elewosi; Salmon, Yasser; Nyaranga, Rosemarie Roma; Ashworth, Jason (Emerald, 2018-02-12)
    • Nice to know: impact of NICE guidelines on ketogenic diet services nationwide

      Whiteley, Victoria; Martin-McGill, Kirsty; Carroll, Jennifer; Taylor, Hannah; Schoeler, Natasha; Royal Manchester Childrens Hospital; University of Salford; University of Chester; University of Liverpool; University of Plymouth; Sheffield Childrens Hospital; UCL Great Ormond Street Institute of Child Health (Wiley, 2019-08-20)
      Background In 2012, the National Institute for Health and Care Excellence (NICE) Clinical Guidelines for Epilepsies: Diagnosis and Management (CG137) included, for the first time, ketogenic diets (KDs) as a treatment option for drug‐resistant paediatric epilepsy. The recommendation was made to refer children and young people with epilepsy whose seizures have not responded to appropriate anti‐epileptic drugs to a tertiary paediatric epilepsy specialist for consideration of the use of KDs. We aimed to assess the impact of this change in guidance on the numbers of ketogenic centres and patients following KDs for epilepsy in the UK and Ireland. Methods An online survey was circulated to ketogenic dietitians from the UK and Ireland. The results were compared with similar surveys published in 2000 and 2010. Results The number of centres offering KDs for treatment of epilepsy has risen from 22 in 2000, to 28 in 2010, and to 39 in 2017 (77% overall increase). Seven of these centres accept adult referrals, in comparison to only two centres in 2010. Patient numbers have increased from 101 in 2000 to 754 in 2017. In total, 267 patients are waiting to commence KD at 31 centres. Conclusions Over the last 7 years, the number of patients treated with a KD for epilepsy in the UK and Ireland has increased by 647%, with a 77% increase in the number of centres offering KDs. Despite this rapid growth, there is ongoing demand for patients to be considered for dietary therapy, highlighting the need for continued expansion of KD services nationally.
    • Sulthiame add-on therapy for epilepsy

      Bresnahan, Rebecca; Martin-McGill, Kirsty; Milburn-McNulty, Philip; Powell, Graham; Sills, Graeme; Marson, Anthony; University of Chester; University of Liverpool; The Walton Centre NHS Foundation Trust; University of Glasgow; Liverpool Health Partners (Wiley, 2019-08-27)
      Background This is an updated version of the Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2015, Issue 10. Epilepsy is a common neurological condition, characterised by recurrent seizures. Most people respond to conventional antiepileptic drugs, however, around 30% will continue to experience seizures, despite treatment with multiple antiepileptic drugs. Sulthiame, also known as sultiame, is a widely used antiepileptic drug in Europe and Israel. We present a summary of the evidence for the use of sulthiame as add-on therapy in epilepsy. Objectives To assess the efficacy and tolerability of sulthiame as add-on therapy for people with epilepsy of any aetiology compared with placebo or another antiepileptic drug. Search methods For the latest update, we searched the Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group’s Specialized Register and CENTRAL (17 January 2019), MEDLINE Ovid (1946 to January 16, 2019), ClinicalTrials.gov and the WHO ICTRP Search Portal (17 January 2019). We imposed no language restrictions. We contacted the manufacturers of sulthiame, and researchers in the field to seek any ongoing or unpublished studies. Selection criteria Randomised controlled trials of add-on sulthiame, with any level of blinding (single, double or unblinded) in people of any age, with epilepsy of any aetiology. Data collection and analysis Two review authors independently selected trials for inclusion, and extracted relevant data. We assessed these outcomes: (1) 50% or greater reduction in seizure frequency between baseline and end of follow-up; (2) complete cessation of seizures during follow-up; (3) mean seizure frequency; (4) time-to-treatment withdrawal; (5) adverse effects; and (6) quality of life. We used intention-to-treat for primary analyses. We presented results as risk ratios (RR) with 95% confidence intervals (CIs). However, due to the paucity of trials, we mainly conducted a narrative analysis. Sulthiame add-on therapy for epilepsy (Review) 1 Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. For Preview Only Main results We included one placebo-controlled trial that recruited 37 infants with newly diagnosed West syndrome. This trial was funded by DESITIN Pharma, Germany. During the study, sulthiame was given as an add-on therapy to pyridoxine. No data were reported for the outcomes: 50% or greater reduction in seizure frequency between baseline and end of follow-up; mean seizure frequency; or quality of life. For complete cessation of seizures during a nine-day follow-up period for add-on sulthiame versus placebo, the RR was 11.14 (95% CI 0.67 to 184.47; very low-certainty evidence), however, this difference was not shown to be statistically significant (P = 0.09). The number of infants experiencing one or more adverse events was not significantly different between the two treatment groups (RR 0.85, 95% CI 0.44 to 1.64; very low-certainty evidence; P = 0.63). Somnolence was more prevalent amongst infants randomised to add-on sulthiame compared to placebo, but again, the difference was not statistically significant (RR 3.40, 95% CI 0.42 to 27.59; very low-certainty evidence; P = 0.25). We were unable to conduct meaningful analysis of time-to-treatment withdrawal and adverse effects due to incomplete data. Authors’ conclusions Sulthiame may lead to a cessation of seizures when used as an add-on therapy to pyridoxine in infants with West syndrome, however, we are very uncertain about the reliability of this finding. The included study was small and had a significant risk of bias, largely due to the lack of details regarding blinding and the incomplete reporting of outcomes. Both issues negatively impacted the certainty of the evidence. No conclusions can be drawn about the occurrence of adverse effects, change in quality of life, or mean reduction in seizure frequency. No evidence exists for the use of sulthiame as an add-on therapy in people with epilepsy outside West syndrome. Large, multi-centre randomised controlled trials are needed to inform clinical practice, if sulthiame is to be used as an add-on therapy for epilepsy
    • Felbamate add‐on therapy for drug‐resistant focal epilepsy

      Shi, Li LI; Bresnahan, Rebecca; Martin-McGill, Kirsty; Dong, JianCheng; Ni, HengJian; Geng, JinSong; Medical School of Nantong University, China; University of Liverpool; University of Chester (John Wiley & Sons, Ltd, 2019-08-01)
      Background This is an updated version of the Cochrane Review previously published in 2017. Epilepsy is a chronic and disabling neurological disorder, affecting approximately 1% of the population. Up to 30% of people with epilepsy have seizures that are resistant to currently available antiepileptic drugs and require treatment with multiple antiepileptic drugs in combination. Felbamate is a second-generation antiepileptic drug that can be used as add-on therapy to standard antiepileptic drugs. Objectives To evaluate the efficacy and tolerability of felbamate versus placebo when used as an add-on treatment for people with drug-resistant focal-onset epilepsy. Search methods For the latest update we searched the Cochrane Register of Studies (CRS Web), MEDLINE, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP), on 18 December 2018. There were no language or time restrictions. We reviewed the reference lists of retrieved studies to search for additional reports of relevant studies. We also contacted the manufacturers of felbamate and experts in the field for information about any unpublished or ongoing studies. Selection criteria We searched for randomised placebo-controlled add-on studies of people of any age with drug-resistant focal seizures. The studies could be double-blind, single-blind or unblinded and could be of parallel-group or crossover design. Data collection and analysis Two review authors independently selected studies for inclusion and extracted information. In the case of disagreements, the third review author arbitrated. Review authors assessed the following outcomes: 50% or greater reduction in seizure frequency; absolute or percentage reduction in seizure frequency; treatment withdrawal; adverse effects; quality of life. Main results We included four randomised controlled trials, representing a total of 236 participants, in the review. Two trials had parallel-group design, the third had a two-period cross-over design, and the fourth had a three-period cross-over design. We judged all four studies to be at an unclear risk of bias overall. Bias arose from the incomplete reporting of methodological details, the incomplete and selective reporting of outcome data, and from participants having unstable drug regimens during experimental treatment in one trial. Due to significant methodological heterogeneity, clinical heterogeneity and differences in outcome measures, it was not possible to perform a meta-analysis of the extracted data. Only one study reported the outcome, 50% or greater reduction in seizure frequency, whilst three studies reported percentage reduction in seizure frequency compared to placebo. One study claimed an average seizure reduction of 35.8% with add-on felbamate while another study claimed a more modest reduction of 4.2%. Both studies reported that seizure frequency increased with add-on placebo and that there was a significant difference in seizure reduction between felbamate and placebo (P = 0.0005 and P = 0.018, respectively). The third study reported a 14% reduction in seizure frequency with add-on felbamate but stated that the difference between treatments was not significant. There were conflicting results regarding treatment withdrawal. One study reported a higher treatment withdrawal for placebo-randomised participants, whereas the other three studies reported higher treatment withdrawal rates for felbamate-randomised participants. Notably, the treatment withdrawal rates for felbamate treatment groups across all four studies remained reasonably low (less than 10%), suggesting that felbamate may be well tolerated. Felbamate-randomised participants most commonly withdrew from treatment due to adverse effects. The adverse effects consistently reported by all four studies were: headache, dizziness and nausea. All three adverse effects were reported by 23% to 40% of felbamate-treated participants versus 3% to 15% of placebo-treated participants. We assessed the evidence for all outcomes using GRADE and found it as being very-low certainty, meaning that we have little confidence in the findings reported. We mainly downgraded evidence for imprecision due to the narrative synthesis conducted and the low number of events. We stress that the true effect of felbamate could likely be significantly different from that reported in this current review update. Authors' conclusions In view of the methodological deficiencies, the limited number of included studies and the differences in outcome measures, we have found no reliable evidence to support the use of felbamate as an add-on therapy in people with drug-resistant focal-onset epilepsy. A large-scale, randomised controlled trial conducted over a longer period of time is required to inform clinical practice.
    • Office workers’ experiences of attempts to reduce sitting-time: An exploratory, mixed- methods uncontrolled intervention pilot study

      Dewitt, Stephen; Hall, Jennifer; Smith, Lee; Buckley, John P; Biddle, Stuart J.H.; Mansfield, Louise; Gardner, Benjamin; University of Chester (BMC Springer Nature, 2019-06-25)
      Background: Office workers typically sit for most of the workday, which has been linked to physical and mental ill- health and premature death. This mixed-methods study sought to identify barriers and facilitators to reducing sitting and increasing standing among office workers who received an intervention prototype (the ‘ReSiT [Reducing Sitting Time] Study’). The intervention comprised a sit-stand workstation and tailored advice to enhance motivation, capability and opportunity to displace sitting with standing. Methods: Twenty-nine UK university office workers (aged ≥18y, working ≥3 days per week, most time spent at a seated desk) participated in a 13-week uncontrolled study. They were initially monitored for one-week. In a subsequent face-to-face consultation, participants received sitting time feedback from a prior one-week monitoring period, and selected from a set of tailored sitting-reduction techniques. Quantitative data comprising sitting, standing and stepping time, which were objectively monitored for 7 consecutive days across three post- intervention timepoints, were descriptively analysed. Qualitative data, from semi-structured interviews conducted at 1, 6 and 12-weeks post-intervention, were thematically analysed. Results: Compared to baseline, mean sitting time decreased at weeks 1, 6 and 12 by 49.7mins, 118.2mins, and 109.7mins respectively. Despite prior concerns about colleagues’ reactions to standing, many reported encouragement from others, and standing could be equally conducive to social interaction or creating private, personal space. Some perceived less cognitively-demanding tasks to be more conducive to standing, though some found standing offered a valued break from challenging tasks. Participants prioritised workload over sitting reduction and were more likely to stand after rather than during work task completion. Temporary context changes, such as holidays, threatened to derail newfound routines. Conclusions: Our findings emphasise the importance of understanding workers’ mental representations of their work, and the social functions of sitting and standing in the workplace. Workplace intervention developers should incorporate a pre-intervention sitting time monitoring period, encourage workers to identify personally meaningful tasks and cues for standing, and build organisational support for sitting-reduction. We will use these insights to refine our intervention for self-administered delivery. Trial registration: ISRCTN29395780 (registered 21 November 2016). Keywords: Sedentary behaviour, Workplace, Qualitative, Occupational health
    • Conceptual and methodological issues relating to pain assessment in mammals: the development and utilisation of pain facial expression scales.

      McLennan, Krista M.; Miller, Amy, L.; Dalla Costa, Emanuela; Stucke, Diana; Corke, Murray J.; Broom, Donald M.; Leach, Matthew C.; University of Chester; Newcastle University; c Università degli Studi di Milano; Havelland Equine Clinic; University of Cambridge; University of Cambridge; Newcastle University (Elsevier, 2019-06-12)
      Effective management of pain is critical to the improvement of animal welfare. For this to happen, pain must be recognised and assessed in a variety of contexts. Pain is a complex phenomenon, making reliable, valid, and feasible measurement challenging. The use of facial expressions as a technique to assess pain in non-verbal human patients has been widely utilised for many years. More recently this technique has been developed for use in a number of non-human species: rodents, rabbits, ferrets, cats, sheep, pigs and horses. Facial expression scoring has been demonstrated to provide an effective means of identifying animal pain and in assessing its severity, overcoming some of the limitations of other measures for pain assessment in animals. However, there remain limitations and challenges to the use of facial expression as a welfare assessment tool which must be investigated. This paper reviews current facial expression pain scales (“Grimace Scales"), discussing the general conceptual and methodological issues faced when assessing pain, and highlighting the advantages of using facial expression scales over other pain assessment methods. We provide guidance on how facial expression scales should be developed so as to be valid and reliable, but we also provide guidance on how they should be used in clinical practice.
    • Promoting patient utilization of outpatient cardiac rehabilitation: A joint International Council and Canadian Association of Cardiovascular Prevention and Rehabilitation position statement

      Santiago de Araújo Pio, Carolina; Varnfield, Marlien; Sarrafzadegan, Nizal; Beckie, Theresa M.; Babu, Abraham S.; Baidya, Sumana; Buckley, John P.; Chen, Ssu-Yuan; Gagliardi, Anna; Heine, Martin; et al. (Elsevier, 2019-07-04)
      Background: Cardiac Rehabilitation (CR) is a recommendation in international clinical practice guidelines given its’ benefits, however use is suboptimal. The purpose of this position statement was to translate evidence on interventions that increase CR enrolment and adherence into implementable recommendations. Methods: The writing panel was constituted by representatives of societies internationally concerned with preventive cardiology, and included disciplines that would be implementing the recommendations. Patient partners served, as well as policy-makers. The statement was developed in accordance with AGREE II, among other guideline checklists. Recommendations were based on our update of the Cochrane review on interventions to promote patient utilization of CR. These were circulated to panel members, who were asked to rate each on a 7-point Likert scale in terms of scientific acceptability, actionability, and feasibility of assessment. A web call was convened to achieve consensus and confirm strength of the recommendations (based on GRADE). The draft underwent external review and public comment. Results: The 3 drafted recommendations were that to increase enrolment, healthcare providers, particularly nurses (strong), should promote CR to patients face-to-face (strong), and that to increase adherence part of CR could be delivered remotely (weak). Ratings for the 3 recommendations were 5.95±0.69 (mean ± standard deviation), 5.33±1.12 and 5.64±1.08, respectively. Conclusions: Interventions can significantly increase utilization of CR, and hence should be widely applied. We call upon cardiac care institutions to implement these strategies to augment CR utilization, and to ensure CR programs are adequately resourced to serve enrolling patients and support them to complete programs.