Background: Malnutrition and poor growth are major problems for many patients with cystic fibrosis (CF), and nutritional supplements can enhance the success of dietary strategies. The purpose of this study was to assess Scandishake (Scandipharm Ltd, U.K.), an energy dense (2.0 kcal/ml) oral supplement. Methods: The study design included a 4‐week monitoring period, followed by 8 weeks of supplementation with Scandishake. The subjects had anthropometry assessed at weeks 0, 4 and 12, and their dietary intake assessed at weeks 0 and 12. Results: Data from 26 patients (16 male, 10 female; age range 9–34 years) showed a significant mean weight increase of 1.9 kg (range 1.6–4 kg) and a mean increase of 0.5 cm (range 1.1–2.7 cm) in mid‐arm muscle circumference. There was also an increase in energy intakes, rising from a mean of 11.15 MJ (2665 kcals) to a mean of 13.42 MJ (3208 kcals) ( P < 0.01), and the mean of individual percentages of estimated average requirement (EAR) for energy increased from 120% (73–182%) to 143% (67–221%). Conclusion: The energy dense formulation of Scandishake makes it a useful adjunct in the treatment of malnutrition and the promotion of normal growth in patients with CF.

How the human brain supports accurate navigation of a learned environment has been an active topic of research for nearly a century 1-5 . In rodents, the theta rhythm within the medial temporal lobe (MTL) has been proposed as a neural basis for fragmenting incoming information and temporally organizing experiences and is thus widely implicated in spatial and episodic memory 6 . In addition, high-frequency theta (~8Hz) is associated with navigation, and loss of theta results in spatial memory deficits in rats 7 . Recently, high-frequency theta oscillations during ambulatory movement have been identified in humans 8,9 , though their relationship to spatial memory remains unexplored. Here, we were able to record MTL activity during spatial memory and navigation in freely moving humans immersed in a room-scale virtual reality (VR) environment. Naturalistic movements were captured using motion tracking combined with wireless VR in participants implanted with an intracranial electroencephalographic (iEEG) recording system for the treatment of epilepsy. We found that prevalence of theta oscillations across brain sites during both learning and recall of spatial locations during ambulatory navigation is critically linked to memory performance. This finding supports the reinstatement hypothesis of episodic memory-thought to underlie our ability to recreate a prior experience 10-12 -and suggests that theta prevalence within the MTL may act as a potential representational state for memory reinstatement during spatial navigation. Additionally, we found that theta power is hexadirectionally modulated 13-15 as a function of the direction of physical movement, most prominently after learning has occurred. This effect bears a resemblance to the rodent grid cell system 16 and suggests an analog in human navigation. Taken together, our results provide the first characterization of neural oscillations in the human MTL during ambulatory spatial memory tasks and provide a platform for future investigations of neural mechanisms underlying freely moving navigation in humans.

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