Folic acid supplement use is involved in the prevention of neural tube defects, the most common major malformations of the central nervous system(1). Women with childbearing potential are advised to take supplements containing 400mcg/day of folic acid in the period preceding pregnancy until the 12th week of pregnancy, while some women (e.g., women with obesity) require a higher dose of 5mg/day(2). Despite these public health recommendations, there is limited translation to folic acid supplement use behaviours(3). In Northern Ireland, data on women’s selfreported periconception folic acid supplement use can be accessed via the Northern Ireland MATernity System. Using this dataset, the current study reports trends of periconception folic acid supplement use (2015-2020), exploring differences based on women’s age, deprivation, pregnancy planning, gravida, and body mass index (BMI) at their antenatal booking appointment.

R, accessed via the UK Secure eResearch Platform, was used to calculate yearly proportions of selfreported periconception folic acid supplement use. To comply with disclosure controls, only complete cases were retained for analyses. When necessary, years were combined (e.g., instead of yearly prevalences, data on BMI was analysed in 2015-2016, 2017-2018, and 2019-2020) and numerical restrictions were applied (e.g., BMI was restricted to values between 14-70kg/m2). Patient and Public Involvement and Engagement strategies were adopted throughout the study.

Analyses included 132,205 pregnancies. Under a third of pregnancies were primigravida (30.90%), and less than half of pregnancies were conceived by women with a BMI within the healthy range (44.75%). In most cases (58.96%), folic acid supplement use was initiated after, rather than before, conception. Preconception supplement use of 400mcg of folic acid declined between 2015 and 2020 (34.40%-30.03%) and was especially low in young women (i.e., <25 years old), women living in the most deprived areas, and women who did not report planning their pregnancy. Although postconception supplement use of 400mcg also declined, trends exhibited a slight increase in the last year (2019: 51.38%; 2020: 53.94%). Preconception and postconception use of supplements containing 5mg of folic acid increased throughout the study period (3.57%-4.98% and 4.02%-7.67%, respectively). The most notable increase was observed among women with obesity, especially those with BMI≥40kg/m2 (preconception: 8.31%-15.70%; postconception: 23.05%-37.97%).

Overall, these analyses of routinely collected maternity data indicate that folic acid supplement use before pregnancy remains suboptimal in Northern Ireland. The use of higher-dose supplements (5mg/day) is increasing for specific population groups, but it remains at a concerning low level particularly in the preconception period. Although based on women’s self-reported folic acid supplement use, these findings can provide valuable insights for policymakers and healthcare professionals, informing the development of future interventions and campaigns. These may include long-term awareness-raising initiatives and preconception support for all women, especially at-risk groups.

Obesity prevalence is rising globally. Living with obesity can lead to increased reproductive challenges and compromise preconception health, defined as the overall health of non-pregnant individuals of childbearing age (15-49 years)(1). Folic acid supplement use, considered a key preconception health behaviour, is pivotal for the prevention of neural tube defects in offspring(2). Guidelines suggest women with obesity take a higher dose (5mg/day) to reduce the risk of fetal complications(3). This research explored trends in Body Mass Index (BMI) in the preconception and early pregnancy period in Northern Ireland (NI) and the prevalence of folic acid supplement use across BMI categories, exploring differences based on deprivation.

Anonymised national data collected in the Northern Ireland MATernity System (NIMATS) were accessed via the UK Secure eResearch Platform Data, provided by the HSC Honest Broker Service. The NI Multiple Deprivation Measure (NIMDM) (2017) aggregates the rankings of seven specific domains into a single ranking, used to categorise deprivation into quintiles for comparison (Q1 highest deprivation vs Q5 least deprivation). Healthy weight, overweight, and obesity were classified as BMI 18.5–24.99kg/m2, 25.00–29.99kg/m2 and ≥30kg/m2, respectively. Folic acid supplement use was self-reported. Multiple linear regressions explored trends in BMI between 2011 and 2021 and χ2 tests explored associations between BMI categories and folic acid supplement use from 2014-2021. The ‘Healthy Reproductive Years’ Patient and Public Involvement and Engagement (PPIE) advisory panel (aged 18-45 years), were involved throughout the study.

The analyses included a total of 255,117 pregnancies, with missing data addressed per variable.

The percentage of women entering pregnancy with a healthy BMI decreased between 2011 and 2021 (48.65%, n = 12,144, and 39.55%, n = 4,316, respectively), while the percentage of women with obesity increased over the same period (18.11%, n = 4,520, and 27.36%, n = 2,986, respectively). Regression models suggested an average increase of ∼1 unit of BMI per calendar year in women entering pregnancy (p<0.001). There were higher proportions of pregnancies conceived by women with overweight or obesity in the highest deprivation quintile (Q1, 53.57%) compared to the least deprivation (Q5, 46.37%). Folic acid supplement use was mostly initiated after conception (59.03%) rather than before (37.54%), as recommended. Among women living with obesity, preconception supplement use of 5mg of folic acid was low (8.74%, n = 2,990). Lower proportions were observed for preconception supplement use of 400mcg among women in the quintile of greatest deprivation (Q1, 21.41%) versus least deprivation (Q5, 44.06%).

Analyses demonstrated an increased number of women entering pregnancy with an elevated BMI and suboptimal preconception folic acid supplement use, particularly for women with obesity. It highlights significant health inequalities according to NIMDM regarding obesity and folic acid supplement use. There is a need to address modifiable preconception health risks, particularly for those from lower socioeconomic groups.

The role of flavonoids on cognitive performance in older adults has been intensively studied, with the subclass of anthocyanins showing promising outcomes(1). However, there is conflicting evidence in the case of individuals at high risk of developing dementia, namely those with mild cognitive impairment (MCI). A recent study has suggested that cognitive scores in people with MCI were higher in those who had higher anthocyanin intake (>10 mg)(2). Baseline data from 65 participants of an ongoing clinical trial that had an MIS (Memory Index Score) score ≤ 13 with self-reported subjective memory complaints, (mean age 69.1y ± 6.2) were used to investigate the relationship between dietary anthocyanin intake and indices of mood and cognitive performance. Repeated 24-hour dietary intake was recorded through Intake24 (a computer-based program) for three days (2Xweekday and 1Xweekend day) and anthocyanin intake was quantified using the PhenolExplorer food composition database. The primary outcome of interest was the Buschke and Grober Free and Cued Selective Reminding Test-Immediate Recall (FCSRT+IR) (assesses auditory anterograde memory functioning), while other cognitive functions assessed included: Spot the Word-2 (assessing premorbid estimate); Oral Symbol Digit Test (speed of processing); List Sorting (working memory); Trail Making Test A & B (speed of processing/executive function); and Verbal Fluency (language/semantic memory). Subjective memory complaints were assessed using the Memory Assessment Clinic-Q (MAC-Q) and mood was assessed using the Geriatric Depression Scale (GDS). Independent t-tests were used to compare differences in cognitive tasks and mood scores between high (>10 mg/d) and low consumers of anthocyanins (<10 mg/d). There was a trend for high anthocyanin consumers (n = 35, median = 44.87 (10.01, 177.83)) to score better on FCSRT-Delayed Free Recall scores (16.57 ± 3.74) compared to lower consumers (n = 30, median = 0.01 (0, 9.51)), (15.97 ± 0.18) with a mean difference (SE) of −1.06 (0.58) (p = 0.06) suggesting recall of 1.06 more words after a 20-30 minute delay. Higher consumers had a lower GDS score (1.77 ± 3.73) compared to lower consumers (3.73 ± 1.77), p = 0.01. Spot the word test scores (assesses premorbid verbal abilities using a robust lexical decision task) were higher for high anthocyanin consumers (53.06 ± 4.38) compared to lower consumers (50.40 ± 4.38), mean difference (SE) = −2.66 (1.10), p = 0.01, meaning participants with higher intake of dietary anthocyanin were able to point at 2.7 more real words than low consumers. Dietary consumption of anthocyanin in older adults with MIS is associated with beneficial effects on depressive scores and the ability to retrieve words. Further research is warranted to identify optimal dosage for recommended intake. This cross-sectional study used baseline data from a randomised controlled trial registered with the Australian New Zealand Clinical Trials Registry (ANZCTR):12622000065796.

Food insecurity, the inadequate or insecure access to food due to financial constraints, is a growing concern in high-income countries like Australia(1). Food insecure adults may have reduced diet quality due to constraints on food purchasing and consumption(2) but further research is needed to understand how the severity of food insecurity impacts diet quality in an Australian setting. This study aimed to examine the relationship between diet quality and increasing severity of household food insecurity using validated measurement tools. A cross-sectional, online survey of Australian adults (aged 18 years+) used the USDA Household Food Security Six-item Short Form to classify respondents as food secure or marginally, moderately, or severely food insecure. The Australian Recommended Food Score (ARFS; score between 0–73) determined diet quality (ARFS total) and sub-scale scores for eight food groups(3), with higher scores indicating higher diet quality. Diet quality score results are further categorised as “needs work” (<33), “getting there” (33-38), “excellent” (39-46) or “outstanding” (47+). Survey-weighted linear regression (adjusted for age, sex, income, education, location, household composition) analyses indicate that 45% of participants were living in households that experienced food insecurity, comprising 7% marginally, 18% moderately and 20% severely food insecure households. The ARFS total survey-weighted mean score for the whole sample (n = 804) was 32.4 (SD = 9.8). As the severity of household food insecurity increased, ARFS scores decreased. Marginally food insecure respondents reported a mean ARFS score three points lower than food-secure adults (B=-2.7; 95%CI [−5.11, −0.34]; p = 0.03), and scores reduced by six points for moderately (B=-5.6; 95%CI [−7.26, −3.90]; p<0.001) and twelve points for severely food insecure respondents (B=-11.5; 95%CI [−13.21, −9.78]; p<0.001). Marginally food insecure respondents had significantly lower vegetable sub-scale scores, moderately food insecure respondents had significantly lower sub-scale scores for all food groups except dairy, severely food insecure respondents had significantly lower scores for all sub-scale scores. Poorer diet quality is evident in adults living with any food insecurity but gets progressively worse as the severity of food insecurity increases. Interventions to reduce food insecurity and increase diet quality are required to prevent adverse nutrition-related health outcomes in food-insecure populations in Australia and beyond.

Postprandial metabolic imbalances are important indicators of later developing cardiovascular disease (CVD)(1). This study investigated the effects of food anthocyanins on vascular and microvascular function, and CVD associated biomarkers following a high fat high energy (HFHE) meal challenge in overweight older adults. Sixteen subjects (13 female, 3 male, mean age 65.9 SD 6.0 and body mass index 30.6 kg/m 2 SD 3.9) participated in a crossover, randomised, controlled, double-blind clinical trial (Australian New Zealand Clinical Trials Registry # ACTRN12620000437965). Participants consumed a HFHE breakfast meal (65g total fat; 33g saturated fat) together with a 250 mL dose of either intervention (Queen Garnet Plum providing 201 mg anthocyanins) or control (apricot) juice. A wash-out period of 14 days occurred between meal challenges, with a 4-day run-in period for juice consumption before each challenge. Blood samples and blood pressure measures were collected at baseline, 2 h and 4 h following the HFHE meal. Vascular function, assessed using flow mediated dilatation (FMD), and microvascular cutaneous vascular reactivity, measured using Laser Speckle Contrast Imaging (LSCI), were evaluated at baseline and 2 h after the HFHE meal. Participants had a higher 2 h postprandial FMD (+1.14%) and a higher microvascular post-occlusive reactive hyperaemia (+0.10 perfusion units per mmHg) when allocated to the anthocyanin compared to the control arm (P = 0.019 and P = 0.049, respectively). C-reactive protein was lower 4 h postprandially in the anthocyanins (1.80 mg/L, IQR 0.90) vs control arm (2.30 mg/L, IQR 1.95) (P = 0.026), accompanied by a trend for lower concentrations of interleukin-6 (P = 0.075). No significant postprandial differences were observed between treatments for blood pressure, triacylglycerol, total cholesterol, serum derivatives of reactive oxidative metabolites, tumor necrosis factor α, interleukin-1 β, or maximum microvascular perfusion following iontophoresis of acetylcholine. Fruit-based anthocyanins attenuated the potential postprandial detrimental effects of a HFHE challenge on parameters of vascular and microvascular function, and inflammatory biomarkers in overweight older adults. Anthocyanins may reduce cardiovascular risk associated with endothelial dysfunction and inflammatory responses to a typical high fat ‘Western’ meal.

In a 2x2 factorial design, (n=6) sheep were either transported by road for 15h or kept in their home pens, and then either starved for 12h with access to water or offered hay ad libitum, with access to water. All groups were offered hay and water 12h after transport. Behavioural observations and measurements of dehydration and feed restriction were made before, during, and for 24h post-transport, to evaluate the implications of these procedures for the welfare of sheep.

After the journey, the immediate priority for the sheep was to eat. Consumption of hay increased water intake and reduced the time spent lying down. The plasma Cortisol concentration was greater in sheep which had been starved during the 12h post-transport period, than in those offered hay during this time; and the plasma free fatty acid concentration was greater in sheep which had been transported than in those which had not. Although transported sheep kept without hay during the first 12h post-transport drank more water than those which had not been transported, the mean time before they drank was greater than 7h. During the transport period, there was less lying behaviour in transported sheep than in non-transported sheep but transported sheep did not lie down more posttransport than non-transported ones. This work suggests that sheep should be offered both feed and water after a 15h journey. However, when feed was not available after a 15h journey, drinking and resting did not appear to be immediate priorities.

This paper provides an overview and appraisal of the International Design Engineering Annual (IDEA) challenge - a virtually hosted design hackathon run with the aim of generating a design research dataset that can provide insights into design activities at virtually hosted hackathons. The resulting dataset consists of 200+ prototypes with over 1300 connections providing insights into the products, processes and people involved in the design process. The paper also provides recommendations for future deployments of virtual hackathons for design research.

Chronic non-cancer pain (CNCP) involves one-third of the US population, and prescription opioids contribute to the opioid epidemic. The Centers for Disease Control and Prevention emphasizes maximizing non-opioid treatment, but many rural populations cannot access alternative therapies. Clinical and Translational Science Award hubs across four rural states performed a multi-site, single-arm intervention feasibility study testing methods and procedures of implementing a behavioral intervention, acceptance and commitment therapy, in primary care CNCP patients on chronic opioids. Using the CONSORT extension for feasibility studies, we describe lessons learned in recruiting/retaining participants, intervention implementation, data measurement, and multi-site procedures. Results inform a future definitive trial and potentially others conducting rural trials.