Impact of anti-obesity medication initiation and duration on weight loss in a comprehensive weight loss programme

OBJECTIVE

This retrospective study aimed to evaluate the impact of anti-obesity medication (AOM) initiation, usage and duration on weight loss in a 72-week precision obesity programme. The type of AOM, diet and exercise plan was chosen based upon an individual's biological and psychosocial needs. The 72-week study duration allowed for a fair investigation of the downstream impact of delayed versus early AOM initiation.

METHODS

Participants, aged ≥18 years with body mass index ≥30 kg m-2, enrolled from 1 March 2015 to 1 April 2017, were included. Subgroups were assigned by AOM usage (users versus non-users, early [before 8 weeks] versus delayed [after 8 weeks] AOM initiation and short [<6 months] versus long [≥6 months] AOM duration). Primary endpoints included change in baseline weight at 72 weeks and proportions achieving ≥5%, ≥10% and ≥15% weight loss. Outcomes were compared between subgroups.

RESULTS

Mean age and body mass index (N = 129) were 45.0 ± 14.0 years and 37.0 ± 6.0 kg m-2, respectively; 67% were female. At week 72, AOM users (N = 71) achieved significantly greater mean percentage reduction in baseline weight than non-users (N = 58). On average, baseline weight decreased by 14.04 ± 6.2% in users versus 10.9 ± 6.8% in non-users (P = 0.008); 84% and 94% of non-user and AOM users lost >5% weight loss (P = 0.006). A higher proportion of users lost ≥15% of weight (45.1% vs. 19.0%; P < 0.001). Mean percentage reduction in weight was greater for early versus delayed starters (-17.60 ± 5.3% vs. -13.95 ± 5.5%; P = 0.024), and longer AOM usage trended towards increased weight loss.

CONCLUSION

Early initiation of AOM may enhance weight loss.

A Combined Theoretical and Experimental Study of Sarin (GB) Decomposition at High Temperatures

Theoretical and experimental results are presented for the pyrolytic decomposition of the nerve agent sarin (GB) in the gas phase. High-level quantum chemistry calculations are performed together with a semiclassical transition-state theory for describing quantum mechanical tunneling. The experimental and theoretical results for the temperature dependence of the survival times show very good agreement, as does the calculated and measured activation energy for thermal decomposition. The combined results suggest that the thermal decomposition of GB, for temperature ranging from 350 to 500 °C, goes through a pericyclic reaction mechanism with a transition state consisting of a six-membered ring structure.

Preventing obesity at weaning: parental views about the EMPOWER programme

BACKGROUND

Infant growth and lifestyle are now recognized as being critical determinants of later obesity. EMPOWER (Empowering Parents to Prevent Obesity at Weaning: Exploratory Research) was developed as an intervention for parents whose babies are at high risk. Delivered by specially trained health visitors, it is underpinned by the Family Partnership Model and uses a strengths-based, solution-focused way of working with families.

METHODS

Mothers of babies participating in the pilot of EMPOWER in Leeds were recruited to take part in a study to examine perceptions about the programme's acceptability and usefulness. Interviews were taped and transcribed, and thematic analysis undertaken.

RESULTS

Families talked positively about the approach of the EMPOWER health visitor with her emphasis on listening, partnership working and shared problem-solving. Parents particularly valued the use of a non-judgemental approach, which they felt had helped them to discuss openly, sensitive issues such as weight and diet. They identified a number of important benefits ranging from increased knowledge about the most appropriate types and amount of food to feed their toddler, to more far-reaching changes within the family as a whole, including modifications to their own diet and lifestyle. Programmes of this nature were perceived as more valuable than the standard help that is currently available.

CONCLUSION

The EMPOWER programme appears to be both acceptable and valued by targeted parents and a potentially effective means of supporting high-risk families to prevent their children from developing obesity. An exploratory randomized controlled trial is now underway to ascertain the feasibility of conducting a definitive phase 3 trial.

Health-Led Interventions in the Early Years to Enhance Infant and Maternal Mental Health: A Review of Reviews

BACKGROUND

  Increasing recognition of the importance of maternal mental health and early parenting in optimising the later mental health of the child has given rise to new ways of working during the perinatal period.

AIMS

  The objective of this review is to identify effective health-led interventions to support parents, parenting and the parent-infant relationship during the perinatal period,¹ and beyond.

METHOD

  A systematic search of key electronic databases was undertaken to identify secondary and primary sources of data addressing the research question. Twenty-four reviews addressed the effectiveness of interventions delivered during the postnatal period in promoting closeness and sensitive parenting, infant sensory and perceptual capabilities, and positive parenting, and in addressing infant regulatory problems, maternal mental health problems, and parent-infant relationship problems.

CONCLUSIONS

  A number of methods of working are recommended as part of a model of progressive-universalism beginning ante-natally and continuing through the first two post-natal years, and beyond. The implications for universal, targeted and specialist healthcare services are explored, alongside the role and contribution of CAMHS practitioners.

Optimization by simulated annealing

There is a deep and useful connection between statistical mechanics (the behavior of systems with many degrees of freedom in thermal equilibrium at a finite temperature) and multivariate or combinatorial optimization (finding the minimum of a given function depending on many parameters). A detailed analogy with annealing in solids provides a framework for optimization of the properties of very large and complex systems. This connection to statistical mechanics exposes new information and provides an unfamiliar perspective on traditional optimization problems and methods.

Gold coast seaway smartrelease decision support system: optimising recycled water release in a sub tropical estuarine environment

Gold Coast Water is responsible for the management of the water, recycled water and wastewater assets of the City of the Gold Coast on Australia's east coast. Excess treated recycled water is released at the Gold Coast Seaway, a man-made channel connecting the Broadwater Estuary with the Pacific Ocean, on an outgoing tide in order for the recycled water to be dispersed before the tide changes and re-enters the Broadwater estuary. Rapid population growth has placed increasing demands on the city's recycled water release system and an investigation of the capacity of the Broadwater to assimilate a greater volume of recycled water over a longer release period was undertaken in 2007. As an outcome, Gold Coast Water was granted an extension of the existing release licence from 10.5 hours per day to 13.3 hours per day from the Coombabah wastewater treatment plant (WWTP). The Seaway SmartRelease Project has been designed to optimise the release of the recycled water from the Coombabah WWTP in order to minimise the impact to the receiving estuarine water quality and maximise the cost efficiency of pumping. In order achieve this; an optimisation study that involves intensive hydrodynamic and water quality monitoring, numerical modelling and a web-based decision support system is underway. An intensive monitoring campaign provided information on water levels, currents, winds, waves, nutrients and bacterial levels within the Broadwater. This data was then used to calibrate and verify numerical models using the MIKE by DHI suite of software. The Decision Support System will then collect continually measured data such as water levels, interact with the WWTP SCADA system, run the numerical models and provide the optimal time window to release the required amount of recycled water from the WWTP within the licence specifications.

WAGR(O?) syndrome and congenital ptosis caused by an unbalanced t(11;15)(p13;p11.2)dn demonstrating a 7 megabase deletion by FISH

Aniridia usually occurs in isolation, but may also occur as part of the WAGR contiguous gene deletion syndrome, which includes Wilms tumor, aniridia, genitourinary abnormalities, and mental retardation. The aniridia and predisposition for Wilms tumor seen in WAGR are caused by haploinsufficiency for PAX 6 and WT1, respectively. We present a female infant with aniridia, bilateral ptosis, bilateral posterior capsular cataracts, nystagmus, left-sided glaucoma, microcephaly, mild unilateral hydronephrosis, poor linear growth, and gross motor delay consistent with a clinical diagnosis of WAGR syndrome. In addition, weight-for-height ratio at 12 months is at the 94th centile, raising the possibility of a diagnosis of WAGRO (WAGR + Obesity). Chromosome analysis revealed a translocation (11;15)(p13;p11.2) which has not been previously associated with a diagnosis of WAGR. Subsequent clinical WAGR fluorescent in situ hybridization (FISH) analysis demonstrated a deletion of 11p13 including PAX6 and WT1. A complete FISH-mapping of the breakpoints on chromosome 11 revealed a 7 Mb deletion within 11p13-11p14. The patient is examined in light of other reported patients with deletions and/or translocations involving the regions between 11p12 --> 11p14 including patients with WAGR + obesity (WAGRO) as well as with other reported patients with aniridia and congenital ptosis.

Mid-infrared spectroscopy of erbium doped chloride laser crystals

We report on a spectroscopic analysis of ErCl3 and 1% Er 3+:YCl3 to determine their potential as possible laser sources at 3.5 and 4.5 mm. Concentration quenching of the low lying excited states is reported to be surprisingly very weak in this system. Although some shortening of the lifetimes is measured in the fully concentrated system, they retain lifetimes that are of order several milliseconds or more. A Judd-Ofelt analysis is performed and the projected gains for the 3.5 and 4.5 mm transitions are calculated. Successful growth techniques of erbium doped chlorides are also described.

The Iowa Articulation Story. Collaboration works

Historically, Iowa has had a majority of diploma and associate degree nursing graduates. Although educational mobility for registered nurses to obtain baccalaureate nursing degrees was available in Iowa before 1991, direct nursing education articulation did not exist. The impetus for developing a statewide nursing articulation plan to facilitate the entry of registered nurses to baccalaureate nursing programs was the result of a recommendation from the Iowa Board of Nursing's 1988 Statewide Plan for Nursing. The Iowa Articulation Plan for Nursing Education: RN to Baccalaureate, implemented in 1991, resulted from collaboration among nurse educators from all levels of nursing and nursing service representatives. The plan consists of four separate options and can be adapted for use in other parts of the country. The Iowa articulation story describes the process used and outcomes achieved when nurses collaborate to advance nursing education.

Localization of a non-specific X-linked mental retardation gene, MRX23, to Xq23-q24

More than 100 X-linked mental retardation syndromes have been described. We report the localization of the disease gene, MRX23, in one family to Xq23-24. Affected family members present with non-specific X-linked mental retardation with verbal disability (BDOAS 10, 1-100). MRX23 is tightly linked to the markers DXS1220 (Z = 3.76 at theta = 0.1) and DXS424 (Z = 3.9 at theta = 0.06). Multipoint linkage analysis, taking five loci (DXS1072-0.07-DXS1220-0.014-MRX23-0.01-DXS 424-0.08-DXS1001) at a time, gives a maximum LOD score of 6.7 between these two markers. The next most likely location, between DXS424 and DXS1001 is 120-fold less likely. Haplotype analysis also indicates the most likely location for the disease gene is between DXS1220 and DXS424.

Using information networks as a decision-making tool

Reforms in healthcare have made the industry more competitive than ever. With budgets being cut all across the country, many healthcare managers are being asked to do more with less, and to do it more quickly. This combination of dynamics creates the need for tools that can help healthcare decision makers make good strategic decisions quickly and confidently. One such tool available to hospitals are information networks. A healthcare information network is an organization that streamlines and expedites decision-making processes by providing healthcare facilities with information that is either too time consuming or impossible for the facility to gather on its own. The information networks conduct research, analyze and condense the findings, and forward relevant data to the member facilities. By outsourcing the tedious research, analysis, synthesis, and presentation of key decision-making data to the information networks, member hospitals free their limited resources to concentrate on the details of the day-to-day operations. In most cases, hospitals that use information networks can also receive the information back more quickly than if they had done the research themselves.

Critical Behavior in the Satisfiability of Random Boolean Expressions

Determining the satisfiability of randomly generated Boolean expressions with k variables per clause is a popular test for the performance of search algorithms in artificial intelligence and computer science. It is known that for k = 2, formulas are almost always satisfiable when the ratio of clauses to variables is less than 1; for ratios larger than 1, the formulas are almost never satisfiable. Similar sharp threshold behavior is observed for higher values of k. Finite-size scaling, a method from statistical physics, can be used to characterize size-dependent effects near the threshold. A relationship can be drawn between thresholds and computational complexity.

Optic atrophy, hearing loss, and peripheral neuropathy

Here we report on two families with a previously apparently undescribed, autosomal dominant disorder resulting in optic atrophy and subsequent development of hearing loss and peripheral neuropathy. This disorder differs from previous syndromes resulting in this triad of effects both in the severity and early onset of the optic atrophy and in its mode of transmission. Review of published cases of optic atrophy + hearing loss + peripheral neuropathy suggests that there are at least three such specific disorders; classification of these published cases by first-appearing symptom also results in a clean division by most-likely inheritance.

Acute hemoperitoneum from rupture of a hepatocellular carcinoma

A male patient with cirrhosis presented with acute right upper quadrant pain, systemic hypotension, and falling hematocrit. Abdominal paracentesis confirmed acute hemoperitoneum, and abdominal computed tomography (CT) scan demonstrated a large hepatic mass consistent with hepatocellular carcinoma (HCC). This rare presentation of a malignancy uncommon in North America leads to a discussion of the differential diagnosis of acute hemoperitoneum and a review of the literature on acute hemoperitoneum and HCC.

Improved survival in variceal hemorrhage with emergent sclerotherapy

Over a 2-yr period (1984-1985) we performed emergent endoscopic injection sclerotherapy (EIS) within 12 h in 25 consecutive episodes of variceal hemorrhage (VH). The outcome was compared to the preemergent period (1982-1984) when 22 episodes of VH were treated first with vasopressin and balloon tamponade, and then by EIS, in cases which failed to resolve. In those with decompensated liver disease, average transfusions dropped from 12.3 to 7.1 units of blood. Continued bleeding decreased from 53% to 13% and mortality from 47% to 13%. Persons with compensated liver disease had fewer recurrent bleeding episodes, and tended toward decreased transfusion requirements and mortality with EIS. Our experience suggests that emergent EIS is the treatment of choice for acute VH.

Effects of contrast material on dimensions and hemodynamics of the newborn heart: a study in conscious newborn lambs

Injections of contrast material (Hypaque M-75%) and normal saline into the left ventricle (LV) of 1- to 3-month-old conscious lambs, during continuous monitoring of LV internal dimensions and pressures, revealed instaneous increases in LV end diastolic and end systolic volumes and LV end diastolic pressure. After contrast material, these alterations were sustained. Contrast injections were also accompanied by a mild depression in LV contractile state (dp/dt/P), systemic vasodilatation and persistent augmentation of cardiac output. The immediate effects on LV dimensions are primarily a consequence of acute volume expansion of the LV by the injection while the sustained changes likely reflect an expanded intravascular volume.