Advanced Footwear Technology (AFT) has enabled remarkable improvements in running performance over traditional marathon racing shoes. However, reported differences between state-of-the-art AFT models are small, and vary across individuals. To assess if the benefits of AFT have been fully realized or if further running economy improvements can be unlocked using modern computational design and optimization techniques, we compared a prototype AFT shoe developed using a data-driven computational design process (PUMA Fast-R 3 (FR3)) against its traditionally developed predecessor model and 2 other state-of-the-art AFT models. We quantified running economy (i.e., the rate of metabolic energy consumption while running at a specified speed) for 15 trained runners (11 males and 4 females) in this prototype AFT shoe and 3 commercially available AFT models: the PUMA Fast-R 2 (FR2), the Nike Alphafly 3 (NIKE), and the Adidas Adios Pro Evo 1 (ADI). Running economy in the FR3 was 3.15% ± 1.24%, 3.62% ± 1.25%, and 3.54% ± 1.16% (mean ± SD) better than in the FR2, NIKE, and ADI (all p < 0.001), respectively, and every individual performed best in the FR3 shoes. While step parameters were similar between FR3 and FR2, the FR3 had a lower step frequency than the ADI (p = 0.013) and longer contact time than the NIKE and ADI (both p < 0.001). Our results suggest that shoes designed using computational design analysis from biomechanical data can improve running economy. This approach appears to be a promising frontier in performance running shoe design, offering potential for further improvements and personalized AFT models.
The aim of this study was to investigate the running economy and biomechanics of runners wearing Advanced Footwear Technology (AFT) spiked shoes (spikes) and AFT shoes relative to traditional spikes. 17 (7 female & 10 male) competitive distance runners completed two sessions of eight (four shoes × two replicates), five-minute trials at 15 km*hr-1 (females) or 17 km*hr-1 (males) wearing Nike ZoomX Dragonfly (NDF) and On Cloudspike 10,000 m (OCS) AFT spikes, Nike Vaporfly Next % 2 (NVN) AFT shoes, and Nike Zoom Victory 3 (NZV) traditional spikes. We measured metabolic rates and ground reaction forces and compared average running economy (W*kg-1) and biomechanical variables from four trials per shoe per runner. When runners wore NDF and OCS AFT spikes and NVN AFT shoes, running economy improved by 2.1%, 2.3%, and 1.9%, respectively, compared to NZV traditional spikes (p < 0.001). These improvements coincided with 6.1%, 4.5%, and 8.9% increases in leg stiffness and 1.5%, 2.2%, and 2.3% increases in ground contact time for the NDF, OCS, and NVN, respectively, compared to NZV traditional spikes (p < 0.002). Running economy improved by 2.1% for athletes wearing compliant AFT spikes and shoes compared to traditional spikes. Future generations of AFT spikes that are designed with further increases in midsole compliance and energy return could improve race performance by eliciting potentially favorable biomechanical changes, such as increased leg stiffness and/or ground contact time.
Shoes incorporating advanced footwear technology (AFT) improve running economy (RE) during level running by ~3%-4% compared to traditional shoes, but the extent to which benefits are preserved on inclines is unclear. Here we investigated the impact of AFT shoes on the energetics of incline running and examined how much benefits are reduced relative to level running. Twelve competitive male runners ran on a treadmill at four gradients (level, 3%, 6%, and 9%) in the Nike ZoomX Vaporfly Next% shoe (VF, AFT) and the Nike ZoomX Streakfly shoe (SF, control) in randomized order. Oxygen consumption was measured using indirect calorimetry, and shoe material properties determined using indentation and cantilever bending tests. The RE benefit of the VF over the SF decreased exponentially with gradient (p < 0.001; R2 = 0.23) from 4.22% during level running, declining by ~20% per 1% increase in gradient, to 2.42% at 3% incline, 1.05% at 6% incline and 0.52% at 9% incline. The VF stored more energy under compression than the SF but had lower resilience. In bending, the VF was ~4-fold stiffer than the SF (4.99 N/mm vs. 1.17 N/mm) with comparable resilience. The exponential decrease in RE benefit with increasing incline suggests that the performance advantage of the VF comes from the elastic properties of the midsole and carbon plate combined, contributing less as the relative importance of elastic mechanisms decreases at steeper inclines. The VF therefore provides the greatest performance benefit on flat courses, with smaller but still present gains on shallow inclines typical of undulating courses.
Advanced footwear technology (AFT) has reshaped distance running performance, but concerns remain regarding its potential biomechanical implications discussed in the injury literature. This study investigates whether the improved running economy provided by AFT occurs without systematic increases in biomechanical variables that have been discussed in the literature in relation to running-related injuries. Thirty recreational runners completed treadmill trials in three shoe conditions: Nike Vaporfly 3 (NV3; PEBA foam + carbon-fiber plate), Nike Invincible 3 (NI3; PEBA foam), and Brooks Levitate 5 (BL5; TPU foam). Running in each shoe was conducted at 10.8 and 12.6 km·h-1. Oxygen uptake, heart rate (HR), and biomechanical variables related to injury risk (vertical average loading rate (VALR), vertical instantaneous loading rate (VILR), braking impulse, contact time, and contralateral pelvic drop) were analyzed using a two-way repeated measures ANOVA. Compared with both NI3 and BL5, NV3 significantly reduced oxygen uptake (mean difference: -1.749 ± 0.259 and -1.914 ± 0.215 mL·kg-1·min-1, respectively, p < 0.001) and HR (mean difference: -4.750 ± 0.637 and -5.433 ± 0.720 beats·min-1, respectively, p < 0.001). The BL5 exhibited substantially higher VALR and VILR than both NV3 and NI3 (all p < 0.001) and NV3 exhibited significantly higher VALR values than NI3 (p = 0.006). Braking impulse was lowest in NI3, and no significant shoe condition effects were observed for contralateral pelvic drop or contact time. AFT shoes combining PEBA foam with a carbon-fiber plate improved running economy without increases in the biomechanical variables examined, which have been discussed in the literature in relation to running-related injuries. AFT shoes can enhance metabolic performance, while PEBA-only shoes may better suit sessions focused on cushioning and impact management.
Advanced footwear technology (AFT) can enhance long-distance running performance by improving running economy (RE). However, the range of the individual improvements is large. Different intra-individual responses in running biomechanics may account for some of the variation. Thus, this randomized within-subject crossover study aimed to identify biomechanical factors associated with changes in RE when running with different AFT models. Twenty-two trained long-distance runners (50% female) ran multiple 5-minute running bouts at their season's best marathon pace (15.0 ± 2.3 km⸱h- 1) while wearing three standardized AFT models (Nike Air Zoom Alphafly Next% 2, Puma Fast-R Nitro Elite v1, Asics Metaspeed Sky+). During each condition, gas exchange data and three-dimensional kinematics and spatiotemporal variables were acquired. RE was determined as the energetic cost of transport. We used two complementary model selection strategies (Akaike Information Criterion model averaging and least absolute shrinkage and selection operator) to identify biomechanical parameters associated with intra-individual differences in RE, and a repeated measures ANOVA to compare RE between shoes at the group level. Across shoe conditions, shorter ground contact time was significantly associated with lower energetic cost of transport (β = 0.025, 95% CI [0.010, 0.040], t(42) = 3.33, p = 0.002), reflecting a ~ 1% improvement in RE per 4 ms decrease. We did not find group-level differences in RE between shoe conditions (p = 0.246). AFT models that reduced runners' individual ground contact time were associated with improved RE. This effect appears to depend on the individual athlete-shoe interaction since no single AFT model stood out as an overall optimum. These findings can help determine optimal footwear for athletes. Future studies should investigate the interaction of AFT properties and individual biomechanics to identify further RE improvements through footwear individualization.
Antibiotics, as a selection stress, could trigger specific responses in bacterial pathogens. This study aimed to investigate adaptive changes of E. coli SM10λpir (pUCP24T) under constant treatment of sub-MIC Gm (gentamicin). E. coli SM10λpir (pUCP24T) underwent continuous passage culture by serial transfer for 50 days on agar plates containing 30 μg/mL Gm to obtain E. coli SM10λpir (pUCP24T)-E. Two strains were compared for the horizontal gene transfer ability, stability of plasmid pUCP24T, fitness cost, and expression of conjugation-related genes. Based on whole genome and RNA sequencing data, functional enrichment analysis (GO and KEGG) was conducted, along with analyses of plasmid sequencing depth, SNPs, and differentially expressed genes (DEGs). The conjugation frequency of E. coli SM10λpir (pUCP24T)-E with recipient PAO1 was higher, and its traI expression was significantly upregulated (p < 0.05). In the same strain, the growth rate and competition index were lower (p < 0.05); the sequencing depth of plasmid pUCP24T and the relative expression of the rep gene were much higher (p < 0.05), but the plasmid showed reduced stability. Functional enrichment analysis suggested a possible enhancement of certain physiological processes and metabolic pathways. A total of 1294 DEGs were detected, with obvious upregulation of hycB, hycD, nikE, cspA, and nanA, and obvious downregulation of gadB, gadC, yeiQ, and yjiH, transcription factors (appY, gadE), and sRNAs (arrS, isrC). Additionally, the expression of aerobic respiratory pathway genes (cyoABCDE) in E. coli SM10λpir (pUCP24T)-E increased significantly (p < 0.05). The enhanced conjugation frequency during adaptation may be attributed to increased expression of the transfer gene traI and an elevated copy number of plasmid pUCP24T. A heavier fitness cost was imposed on the host during this process. Aerobic respiration and metabolic efficiency were likely potentiated. sRNA isrC was hypothesized to inhibit aerobic respiration by targeting the cytochrome bo oxidase subunit cyoD.
Shoe donning and doffing are a daily challenge for older adults and persons with conditions such as diabetes, stroke, arthritis, and Parkinson's disease, yet closure mechanisms have received little attention compared with sole design and slip resistance. This narrative review examines seven shoe closure technologies from the perspectives of mechanical performance and functional accessibility for persons with reduced mobility. A narrative review was conducted drawing on peer-reviewed literature, patents, and industry sources identified through Scopus, Web of Science, PubMed, Google Scholar, and patent databases (USPTO, EPO, WIPO). Sources were selected for their relevance to shoe closure mechanism design, footwear-related functional limitations, or adaptive footwear technology. A total of 44 sources were synthesised, spanning mechanical engineering, rehabilitation science, and clinical literature. Seven closure technology categories were examined: traditional lacing, hook-and-loop (Velcro), buckle/strap, elastic/slip-on, magnetic, dial-wire (BOA), and bistable hinge/hands-free. Each was assessed against six performance dimensions: engagement force, holding security, release controllability, durability, cost accessibility, and hands-free operability. Based on the available evidence, no existing technology satisfies all six criteria simultaneously. Recent hands-free designs (Nike GO FlyEase, Kizik) represent meaningful engineering advances but remain priced beyond the reach of most users in low- and middle-income countries (LMICs). No existing closure technology simultaneously achieves hands-free operation, adequate holding security, long-term durability, and LMIC cost accessibility. Passive mechanical closures based on geometric interference represent a promising but empirically unvalidated direction. The absence of standardised test protocols for closure performance remains a structural barrier to evidence-based clinical prescription. Hook-and-loop (Velcro) closures remain the most common clinical recommendation but exhibit 30–50% degradation in holding force after approximately 10,000 cycles. Clinicians should inform patients of this limitation and recommend periodic strap inspection and replacement.Elastic slip-on closures provide hands-free convenience but are prone to progressive loosening due to material creep, which may increase the risk of foot slippage and falls. This trade-off should be explicitly discussed during prescription and fitting.No currently available hands-free closure technology meets both performance requirements and LMIC affordability thresholds. In resource-limited settings, clinicians will continue to rely on hook-and-loop systems while emphasising proper maintenance and timely replacement.Closure selection should be individualised by matching the mechanism to each patient’s grip strength, dexterity, and functional limitations, considering engagement force, holding security, durability, and hands-free capability rather than defaulting to a single type, combined with clear patient and caregiver education to improve adherence and reduce device abandonment.
Understanding which psychological traits promote a flow state is crucial in the sport environment. This study aimed to examine whether personality and perfectionism among athletes were associated with the experience of dispositional flow. A sample of 216 athletes (Mage = 25.30; SD = 8.67; 129 men) completed self-report measures. Results of the partial least squares path modeling approach showed that extraversion was significantly positively associated with challenge skill balance, awareness, merging of action, clear goals, loss of self-consciousness, unambiguous feedback, and transformation of time. In addition, agreeableness was significantly negatively associated with sense of control. Besides, conscientiousness was significantly negatively associated with sense of control, clear goals, and autotelic experience. Finally, emotional stability was significantly positively associated with the transformation of time. In conclusion, it is important to highlight the influence of personality in the flow experience, which may hinder the performance of those athletes who have not developed certain personality traits. Also, it is noteworthy that extraversion is among the most salient personality variables in relation to flow. This has practical psychological implications for developing healthy environments and for identifying risk profiles that endanger well-being and performance among athletes.
Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disorder caused by MEN1 gene mutations, typically involving primary hyperparathyroidism (PHPT), pancreatic neuroendocrine tumors (PanNETs), and/or pituitary neuroendocrine tumors (PitNETs). However, 10-30% of patients with MEN1-like features lack identifiable MEN1 mutations and are classified as phenocopies. This retrospective multicenter study, conducted across 10 Italian referral centers, aimed to characterize the main clinical features of phenocopies. Among 240 patients evaluated for suspected MEN1 over five years, 175 (mean age 43.2 ± 19.7; 101 females) had genetically confirmed MEN1, while 65 (27%; mean age 59.9 ± 11.6; 44 females) were identified as phenocopies. Of these, 46 (70.7%) were also negative for CDKN1B mutations, confirming the rarity of MEN4. Phenocopies were diagnosed one to two decades later than MEN1 patients (p < 0.0001). PHPT was the most frequent manifestation in both groups (80% of phenocopies vs. 81% of MEN1), but tumor associations differed significantly between groups (p < 0.001): 41% of MEN1 patients showed the classic triad, compared to only 1% of phenocopies; PHPT with NETs was more common in MEN1 (32%), whereas PHPT with PitNETs occurred more often in phenocopies (54%), reflecting patterns of sporadic tumors. Notably, 11% of phenocopies had a first-degree relative with MEN1-related diseases, and 51% had a personal or family history of cancer. In conclusion, MEN1 phenocopies are relatively common and represent a clinical challenge. Given their distinct features and familial backgrounds, an extended genetic panel should be offered to these patients together with periodical screening of MEN1-related disease.
Advanced footwear technology (AFT) spikes are commonly offered in two configurations: foam only and foam combined with a carbon fiber plate. Whether the plate provides additional metabolic or performance benefits over foam-only designs remains uncertain. Therefore, this study compared physiological, biomechanical, and perceptual responses to two commercially available AFT spikes (Nike ZoomX Dragonfly, foam only; Nike Air Zoom Victory, foam plus carbon plate) in trained and national-level distance runners. Thirteen male middle- and long-distance runners (trained, n = 6; national-level, n = 7) completed three randomized 1600-m submaximal trials on an outdoor track at 16 km·h-1 (trained) or 18 km·h-1 (national-level). Running economy (RE) was assessed using a portable gas analyzer (MetaMax 3B-R2); spatiotemporal gait variables were recorded with shoe-mounted sensors (RunScribeTM); and participants rated comfort, cushioning, and perceived performance on a 10-point Likert scale. In the national-level group, both foam-only spikes (Dragonfly1, Dragonfly2) produced better RE than the carbon-plated model (Victory1), with no difference between the two foam-only versions. In the trained group, RE did not differ across spikes. Energetic cost paralleled the VO2 findings. For gait parameters, stride length and step frequency were unchanged across conditions in both groups. Whereas contact time in the national-level group was longer in Dragonfly1 than in Dragonfly2 and Victory1, whereas Dragonfly2 and Victory1 did not differ; in the trained group, contact time was unchanged across spikes. Subjectively, across all participants, foam-only spikes were rated more comfortable and more cushioned, whereas perceived performance did not differ between models. At long-distance race paces, foam-only AFT spikes improved RE and were perceived as more comfortable than a plate-integrated spike in national-level athletes. Adding a carbon plate did not guarantee a metabolic benefit and may increase energetic cost when shoe stiffness exceeds an athlete-specific optimum. Spike selection, particularly for track events, should demystify carbon plates and prioritize the individualized selection of shoe stiffness and geometry matched to event distance, running speed, and athlete-specific biomechanics.
Wireless ultrasound probes offer a quicker, more affordable option for muscle quality assessment compared with standard cart units, yet their effectiveness for evaluating larger muscles such as the rectus femoris in terms of cross-sectional area (CSA) and echo-intensity (EI) is unclear due to limited field of view. This study evaluates whether rectus femoris thickness and EI measured with a wireless probe correlate with CSA and EI obtained from a standard cart ultrasound. A cross-sectional, convenience sample of 29 division I college female athletes (age: 20.1 [1.1] y, height: 169.7 [7.4] cm, mass: 69.7 [10.0] kg) were recruited. Panoramic thigh ultrasound images were acquired with a standard ultrasound cart to assess the rectus femoris CSA and EI at 50% of the thigh length. A wireless ultrasound probe was used to acquire stationary images with the knee in the same position to assess rectus femoris thickness and EI. A Pearson product-moment correlation was used to determine the association between the muscle outcomes obtained with the standard cart ultrasound and wireless ultrasound probe. Standard ultrasound CSA (10.1 [2.0] cm2) and wireless ultrasound thickness (2.0 [0.3] cm) were strongly associated (r = .71, P < .001). Standard ultrasound EI (56.2 [5.1] arbitrary units) and wireless ultrasound EI (62.0 [6.3] arbitrary units) were moderately associated (r = .49, P = .007). Wireless ultrasound offers a fast and accessible method for assessing muscle thickness in female division I athletes when compared with similar muscle size and quality metrics measured on panoramic images acquired with a standard ultrasound cart. The echogenicity indices from wireless and standard ultrasound are significantly associated between units; however, wireless ultrasound systematically overestimates echogenicity compared with the standard.
Basic psychological needs (i.e. autonomy, competence and relatedness) are strongly linked to well-being, motivation and engagement. However, there is limited research detailing which antecedents most effectively promote the satisfaction of these needs. This study investigates the role of individual resilience as a personal factor that may be associated with the fulfillment of basic psychological needs in the healthcare context. Drawing on conservation of resources and self-determination theories, this study employs a cross-sectional survey administered to 91 Italian healthcare professionals working in Family Counseling Centers. Validated scales from the literature were used to assess both individual resilience and basic psychological needs satisfaction. Data were analyzed using hierarchical regression analyses to evaluate the associational role of individual resilience in need fulfillment. The results suggest that individual resilience is positively associated with the satisfaction of autonomy, competence, and relatedness needs among healthcare professionals. Healthcare workers with higher resilience tend to report greater fulfillment of basic psychological needs, which is consistent with theoretical expectations regarding motivation, emotional stability and well-being at work. Previous research has predominantly focused on the outcomes associated with basic psychological needs satisfaction, such as enhanced well-being, increased motivation and improved performance. While antecedents have often been examined at the organizational and relational levels, this study is among the first to empirically explore the role of individual resilience as a potential antecedent within the healthcare sector. By identifying how personal resources may relate to psychological need satisfaction, this work provides practical insights to inform interventions aimed at supporting healthcare professionals' motivation and resilience.
We tested the hypothesis that marathon racing reduces working memory performance and increases frontal theta activity in trained female endurance athletes. We further examined whether changes in cognitive performance or brain activity were associated with either acute and/or chronic risk of low energy availability. Sixteen female Tier 2 runners (42 ± 9 yr; VO 2 max 45.6 ± 6 mL·kg - ¹·min - ¹) underwent VO 2 max testing and the Low Energy Availability in Females Questionnaire (LEAF-Q) 7-14 d before a marathon. Participants completed 1-back (low-load) and 3-back (high-load) working memory tasks during electroencephalogram recordings, performed before and immediately after the race (<10 min). Accuracy and reaction time measured cognitive performance, and frontal theta power measured cognitive effort. Sixteen runners completed the marathon in 4:16 ± 37 min (70 ± 6% VO 2 max), with a mean carbohydrate intake of 28 ± 14 g·h -1 . Six athletes exceeded the LEAF-Q threshold (≥8) and eight reported menstrual dysfunction. Postrace, 3-back accuracy declined (-18.8%, P = 0.003) while reaction time shortened for both task versions (5.3%-6.6%, P = 0.002). Frontal theta increased postrace (1-back: +26.8%; 3-back: +29.6%, P < 0.001). Regression models showed that 3-back accuracy changes were predicted by LEAF-Q score (β = 0.494, P = 0.016). In contrast, theta increases were predicted by a combination of lower carbohydrate intake (β = -0.025, P = 0.005), longer race time (β = 0.008, P = 0.005), and higher LEAF-Q score (β = 0.121, P < 0.001). Working memory performance is reduced and cognitive effort is increased after marathon racing in trained female athletes. These effects are linked to both acute and chronic risk of low energy availability, emphasizing the need for individualized fueling strategies to preserve cognitive performance during endurance events.
Diabetes mellitus (DM) and cancer are major global health challenges that increasingly coexist due to shared risk factors including aging, obesity, sedentary behavior, and chronic low-grade inflammation. Beyond being a common comorbidity, DM-particularly type 2 diabetes-has emerged as an important modifier of cancer risk, progression, treatment tolerance, and survival. Epidemiological studies consistently associate DM with a higher incidence of several malignancies, including pancreatic, liver, colorectal, breast, and endometrial cancers, as well as increased cancer-specific and overall mortality. The biological link between dysglycemia and cancer is complex and multifactorial. Chronic hyperglycemia, hyperinsulinemia, and insulin resistance promote tumor development and progression through altered cellular metabolism (Warburg effect), activation of insulin and insulin-like growth factor pathways, systemic inflammation, oxidative stress, immune dysfunction, and changes in the tumor microenvironment and gut microbiota. This review summarizes current evidence on the interplay between dysglycemia and cancer and explores how integrating continuous glucose monitoring (CGM)-based strategies into multidisciplinary oncology care may improve both metabolic and oncologic outcomes. A comprehensive search of online databases, including PubMed, ISI Web of Science, and Scopus, was conducted to identify studies assessing the impact of glycemic disturbances and glycemic control on cancer outcomes. Poor glycemic control and increased glucose variability are associated with worse oncologic outcomes, higher rates of treatment-related complications, reduced adherence to therapy, and diminished efficacy of chemotherapy, targeted agents, and immune checkpoint inhibitors. Severe hypoglycemia has also emerged as an independent predictor of poor prognosis. Although HbA1c has long been the cornerstone of glycemic assessment, it incompletely captures the dynamic glucose fluctuations commonly observed during cancer therapy. CGM provides a more comprehensive and clinically meaningful assessment of glycemic control, with the potential to reduce hypoglycemia, improve glycemic stability, and enhance tolerance and adherence to anticancer treatments. Current evidence indicates that diabetes and dysglycemia are key modifiers of cancer risk, progression, treatment tolerance, and survival. Optimizing glycemic control may therefore contribute to improved cancer outcomes. CGM represents a promising tool for personalizing diabetes management in oncology settings.
Musculoskeletal disorders, including chronic back pain, osteoarthritis, rheumatoid arthritis, and fibromyalgia, are leading causes of chronic pain and reduced quality of life. Standard treatment approaches often focus on physical symptoms, while psychosomatic factors are sometimes overlooked. This study aims to evaluate the effectiveness of adjunct psychosomatic interventions-guided meditation and aromatherapy-on pain perception, stress levels, and quality of life in patients with musculoskeletal disorders. This is a three-arm, prospective, randomized controlled trial conducted in Germany. A total of 90 participants aged 18 to 90 with chronic musculoskeletal disorders will be randomized into one of three groups: (1) guided meditation, (2) aromatherapy, or (3) control receiving standard care. The intervention groups will receive either body-scan meditation (23 min, twice weekly) or aromatherapy (5-10 min daily) for one week. The primary outcomes include pain intensity (measured using the Numerical Rating Scale), perceived stress (measured using the Perceived Stress Questionnaire), and quality of life (measured using the EQ-5D). Secondary outcomes will include pain medication consumption. Follow-up assessments will be conducted at 3-, 6-, and 12-month post-intervention. Data will be analyzed using an intention-to-treat approach with ANCOVA for primary endpoints. This trial will provide valuable insights into the effectiveness of psychosomatic interventions as adjunct therapies for managing chronic pain and stress in musculoskeletal disorders. If successful, these interventions could be implemented as cost-effective and non-invasive strategies to improve quality of life and pain management for patients with musculoskeletal conditions. The findings may also inform future studies on integrative treatment approaches for chronic pain conditions. The trial is registered at the German Clinical Trials Register ( https://www.drks.de ), registration number DRKS00034506.
The aim of this study was to identify shared and distinct metabolite profiles prospectively associated with nephropathy, retinopathy and neuropathy at 15 years' follow-up among 1947 participants in the Diabetes Prevention Program Outcomes Study, the long-term follow-up of the Diabetes Prevention Program (DPP). We applied bootstrapped LASSO to 353 annotated metabolites to identify metabolites associated with one or more complication. For these metabolite hits, we tested for an interaction with DPP treatment arm, and ran multivariable models for the pooled sample or within treatment group as appropriate. At follow-up, 572 participants had one or more complication (n=277 nephropathy, n=194 retinopathy, n=212 neuropathy). Of 105 metabolites that predicted any complication, 74 predicted one, 27 predicted two, and four predicted all three. In a pooled analysis of 69 metabolites without treatment arm interactions, histidine predicted lower odds of nephropathy (OR 0.75; 95% CI 0.69, 0.88), and serine predicted lower odds of nephropathy (OR 0.69; 95% CI 0.58, 0.82) and neuropathy (OR 0.68; 95% CI 0.56, 0.84). Of 36 metabolites that interacted with treatment arm, higher N-carbamoyl-β-alanine predicted greater odds of nephropathy (OR 1.99; 95% CI 1.38, 2.99) and C22:0-sphingomyelin predicted lower odds of neuropathy (OR 0.54; 95% CI 0.37, 0.77) in the metformin arm. In the lifestyle intervention arm, quinolinic acid predicted greater odds of neuropathy (OR 1.64; 95% CI 1.24, 2.19). These estimates accounted for sex, race, baseline age, BMI and smoking, and time elapsed during follow-up. Further adjustment for HbA1c during follow-up, incident diabetes and eGFR did not change the results. The existence of distinct metabolite profiles associated with single microvascular complications highlights the importance of characterising pathophysiological mechanisms specific to each complication, in addition to studying shared mechanisms across multiple complications.
BACKGROUND: This study aimed to examine the independent and joint associations of chronic heat exposure and physical activity (PA) with the risk of developing knee osteoarthritis (KOA). METHODS: We analyzed data from 352,904 participants in the UK Biobank cohort, free of KOA at baseline. Chronic heat exposure was quantified as the proportion of days with daily maximum temperature > 27 °C during the 5 years before baseline and dichotomised at the 75th percentile. PA was assessed at baseline via the International Physical Activity Questionnaire and classified as low, medium, or high. Incident KOA (ICD-10, M17) was ascertained through linked health records. Cox proportional hazards models evaluated associations. Sensitivity analyses included alternative heat cut-offs, alternative heat windows, 1- and 2-year landmark analyses, and an accelerometer sub-cohort. RESULTS: Over a mean follow-up of 11.3 years, 23,146 KOA cases were identified. In fully adjusted models, high heat exposure was associated with a modestly lower KOA risk compared with low heat exposure (HR 0.90, 95% CI 0.87–0.93). Relative to high PA, both medium and low PA were associated with lower KOA risk (HR 0.93 for both). In joint analyses, high heat exposure was associated with lower KOA risk within each PA category; within the high-heat group, both medium and low PA showed similarly reduced risk relative to high PA. Findings were directionally consistent across sensitivity analyses. CONCLUSIONS: Chronic heat exposure was associated with a lower risk of incident KOA, and higher total weekly physical activity volume was associated with a higher KOA risk. In joint analyses, high heat exposure was associated with lower KOA risk within each physical activity category. CLINICAL TRIAL NUMBER: Not applicable.
Background: Intellectual disability limits physical activity, affecting health and quality of life. Efficient tests to assess cardiorespiratory fitness in adapted football are essential. The Six-Minute Walk Test (6MWT) is a widely used benchmark test but can be logistically challenging. Although alternative tests such as the Sit-to-Stand Test (STST), Chester Step Test (CST), and Two-Minute Step Test in Place (2MST) have been validated in other populations, no study has examined their relationship with the 6MWT specifically in football players with intellectual disability, a population with unique physiological and cognitive characteristics. Therefore, this study reports the convergent validity between the 6MWT and these alternative field tests and describes the physiological responses to each test in football players with intellectual disability. Methods: Forty-two adult male football players with intellectual disability (mean age 27.1 ± 5.6 years) completed the 6MWT, STST, CST and 2MSPT. Physiological parameters, including heart rate, oxygen saturation (SpO2), and systolic and diastolic blood pressure, were recorded before and after each test. Pearson's correlation coefficients were calculated to assess relationships among tests. Results: Strong, significant correlations were found between the 6MWT and the STST (r = 0.711), CST (r = 0.724), and 2MSPT (r = 0.683) (all p < 0.001). All tests induced expected changes in heart rate, blood pressure and oxygen saturation. Conclusions: The STST, CST and 2MSPT showed strong associations with the 6MWT and may serve as practical, safe and efficient complementary tools for field-based assessment of cardiorespiratory fitness in this population. These findings apply specifically to adult male football players with intellectual disability and should not be generalized to other populations with intellectual disability.
Equity, diversity and inclusiveness have been identified as areas for improvement across sports and biomechanics research. To identify and prioritise areas for improvement, it is important to understand the current 'state of play'. This protocol outlines an audit process designed to (1) characterise and compare demographic data of both participants and researchers in published performance shoe research and (2) profile considerations of equity, diversity and inclusiveness in performance shoe design. A comprehensive multi-language, search strategy will be conducted across 4 primarily English and 1 Chinese data base. Sport specific journals published in Chinese, Japanese, Korean, French, Spanish and Portuguese will be hand-searched. All studies, published since 2015, investigating the design or testing of a shoe, insert or orthotic required or facilitating for sports performance will be considered for inclusion. For the purposes of this audit, sports will be limited to those recognised by the International Olympic Committee Summer Olympic International Federations. Footwear company websites will be searched for details on specific performance footwear. Studies will be grouped based on the sports the shoe is designed for. Participants' gender and/or sex, race and ethnicity will be directly extracted from included studies or by contacting the authors. Researchers' gender and/or sex, position within the authorship group and location where the study was conducted will be extracted from included studies or obtained through university profiles, professional pages or by directly contacting authors. Differences in demographic data will be compared between shoe type and representativeness of participants, researchers and footwear will be calculated using participation to prevalence ratios. The proposed protocol represents a committed step towards improving equity, diversity and inclusiveness throughout footwear science.
Suicide is currently the second leading cause of death among youth ages 13-24 in the United States. Youths presenting to Emergency Departments (EDs) with suicidal ideation and/or behavior have elevated risk for subsequent suicide attempts and deaths, yet optimal approaches to emergency care remain unclear and too many youths receive inadequate follow-up treatment after discharge. Using a community partnered participatory research model, this multi-site single-blinded randomized comparative effectiveness trial investigates two strategies for enhancing emergency care for 1600 adolescents and young adults (ages 13-24) presenting with suicide attempts and/or suicidal ideation: 1) ED care enhanced by increased access to a developmentally tailored approach to safety planning; and 2) a combined approach that supplements enhanced ED care with brief therapeutic contacts with youths and parents/significant others for 12 months after ED-discharge. These contacts by phone/video/text/letter feature support, brief intervention, and case management. Youths will be recruited from four geographically diverse locations, and assessed at baseline and 3, 6, and 12-month follow-ups. Parent assessments will be at: baseline; 12-month follow-ups; and when youth report is unavailable. Outcomes will be assessed in two domains: 1) clinical [suicide attempts primary, self-harm (suicide attempts+nonsuicidal self-harm) secondary]; 2) service use (linkage to outpatient mental health care primary, treatment dose secondary). Exploratory outcomes and heterogeneity of treatment effects will be evaluated. The trial is designed to have public health impact by clarifying the added value of therapeutic follow-up contacts after discharge, relative to ED care emphasizing evaluation, safety planning, and referral for follow-up care.