Factors Associated With Long Term Weight Regain After Bariatric Surgery

Background. Although bariatric surgery is an effective treatment for morbid obesity, long-term weight regain is a significant problem after surgery. Few studies have assessed the association between eating behaviors, psychological factors and lifestyle factors as well as postoperative factors and long term weight regain. This study assesses all of these factors in patients who have undergone gastric bypass (GBP) and laparoscopic adjustable banding (LAGB) procedures. Methods. One hundred eighty patients who underwent primary GBP (n=128) and LAGB (n=52) between 1996 and 2006 with at least five years of follow up data available were included in this study. Patient characteristics, preoperative eating, lifestyle and psychological factors, were assessed across both procedures and for each procedure separately to determine whether they were predictors of substantial long term weight regain. Similar analyses were conducted in each procedure group to determine the association between postoperative outcomes, follow-up and eating and exercise behaviors, and substantial long-term regain. Substantial weight regain was defined as a regain of at least 30% or more of lost weight. Results. Percent weight regain was found to be greater in LAGB compared to GBP (41.0% versus 28.3%, p=.0042). Multivariate analyses showed that confidence in weight loss was a predictor of substantial regain in all patients. Past illicit drug use was a predictor of substantial regain in GBP patients (OR: 1.5, p=.02). LAGB patients who reported eating large portions or frequently dining out before surgery were less likely to exhibit substantial regain (OR: 0.68, p=.0475 and OR: 0.64, p=.004, respectively). Years of follow up showed an increased odds of regain after GBP (OR: 1.05, p=.03). No postoperative factors were associated with regain in LAGB patients. Conclusions. These findings suggest that GBP may maintain weight loss more effectively than LAGB, however past drug users may be at risk for regain after GBP. Patients whose problem preoperative behaviors are primarily eating large portions or frequently dining out may be good candidates for LAGB. Patients who exhibit any lack of confidence in their ability to achieve and maintain weight loss success may be at greater risk of long term regain. Tailored counseling is warranted to address these specific issues in bariatric surgery patients in order to reduce the risk of regain

Spinal manipulation under anesthesia: a narrative review of the literature and commentary

As exhibited throughout the medical literature over many decades, there is a lack of uniformity in the manner in which spine pain patients have historically qualified for and received manipulation under anesthesia (MUA). Also, for different professions that treat the same types of spinal conditions via the same means, fundamental MUA decision points vary within the published protocols of different professional associations. The more recent chiropractic literature communicates that the evidence to support the efficacy of MUA of the spine remains largely anecdotal. In addition, it has been reported that the types of spinal conditions most suitable for MUA are without clear-cut consensus, with various indications for MUA of the low back resting wholly upon the opinions and experiences of MUA practitioners. This article will provide a narrative review of the MUA literature, followed by a commentary about the current lack of high quality research evidence, the anecdotal and consensus basis of existing clinical protocols, as well as related professional, ethical and legal concerns for the chiropractic practitioner. The limitations of the current medical literature related to MUA via conscious/deep sedation need to be recognized and used as a guide to clinical experience when giving consideration to this procedure. More research, in the form of controlled clinical trials, must be undertaken if this procedure is to remain a potential treatment option for chronic spine pain patients in the chiropractic clinical practice

Heterodyne Array Receivers for Space and Ground Based Applications

The first heterodyne array receivers have been successfully built for ground-based telescopes and airborne observatories. In the talk we give a very quick overview of some prior heterodyne arrays. In particular, we will look at the innovations they introduced and how these could be applied to future large (100 to 1000 pixel) arrays or space missions. Then we will present the first detailed design for a space application, the Heterodyne Receiver for the Origins Space Telescope (HERO). HERO follows the traditional design, but limited cooling power and the limited electrical power of the satellite pose major challenges. Minor challenges are limited availability of space and weight. For the eight 3x3 pixel arrays of which 4 can operate simultaneously we attributed 20mW at 4.5K, 35mW at 35K and 205 W at the satellite temperature. Therefore we propose to use SiGe cryogenic low noise amplifiers, with a dissipation of about 0.5mW for 6 GHz bandwidth. The power of the backends also needs to be reduced drastically to about 1 W for 6 GHz bandwidth. CMOS ASIC backends are one option, ADC, followed by FFTs and ACCs another. To reduce the volume and mass, we propose the cover the RF bandwidth of 486 GHz to 2700 GHz in only 4 bands, each with about 50% relative width.The design might not only be a helpful starting point for any heterodyne array on a satellite, but the low heat and power consumption might be also an essential first step for large (100 to 1000 pixels) heterodyne arrays for ground based telescopes or simply a more energy efficient alternative for any ALMA single pixel or array receiver

APOLO-Bari, an internet-based program for longitudinal support of bariatric surgery patients: study protocol for a randomized controlled trial

Background: Despite evidence of successful weight loss for bariatric surgery patients, some patients experience considerable weight regain over the long term. Given the strong association between post-surgery health behaviors and outcomes, aftercare intervention to address key behaviors appears to be a reasonable relapse-prevention strategy. As the burden of obesity rates increases in healthcare centers, an internet-based program appears to be a reasonable strategy for supporting bariatric surgery patients in the long term. The primary purpose of the current project is to develop and test the efficacy and perceived utility of APOLO-Bari.Methods/design: This study is a randomized control trial, which will be conducted in two hospital centers in the North of Portugal; it includes a control group receiving treatment as usual and an intervention group receiving the APOLO-Bari program for one year in addition to treatment as usual. A total of 180 male and female participants who underwent bariatric surgery (gastric sleeve or gastric bypass surgery) for 12 to 20 months will be recruited. Both groups will complete a similar set of questionnaires at baseline, every 4 months until the end of the intervention, and at 6 and 12 months follow-up. Assessment includes anthropometric variables and psychological self-report measures. The primary outcome measure will be weight regain measured at the end of treatment, and at 6 and 12 months follow-up. The secondary aims are to test the cost-effectiveness of the intervention and to investigate psychological predictors and trajectories of weight regain. APOLO-Bari was developed to address the weight regain problem in the bariatric population by offering additional guidance to bariatric patients during the postoperative period. The program includes: (a) a psychoeducational cognitive-behavioral-based self-help manual, (b) a weekly feedback messaging system that sends a feedback statement related to information reported by the participant, and (c) interactive chat sessions scheduled witThis research was partially supported by the Fundacao para a Ciencia e a Tecnologia through a European Union COMPETE program grant to Eva Conceicao (IF/01219/2014 and PTDC/MHC-PCL/4974/2012), a doctoral scholarship to Ana Pinto-Bastos (SFRH/BD/104159/2014), a doctoral scholarship to Sofia Ramalho (SFRH/BD/104182/2014), and a postdoctoral scholarship to Ana Rita Vaz (SFRH/BPD/94490/2013), co-financed by FEDER under the PT2020 Partnership Agreement (UID/PSI/01662/2013).info:eu-repo/semantics/publishedVersio

Homogenization of nonlinearly elastic materials, microscopic bifurcation and macroscopic loss of rank-one convexity

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46162/1/205_2004_Article_BF00380256.pd

Crise da educação, formação de professores, reformas educacionais e utopia: algumas reflexões

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Analysis and Modeling of Linear-Switched Reluctance for Medical Application

This paper focuses on the analysis, the modeling and the control of a linear-switched reluctance motor. The application under consideration is medical, and the actuator is to be used as a left ventricular assist device. The actuator has a cylindrical or tubular shape, with a mechanical unidirectional valve placed inside the mover, which provides a pulsatile flow of blood. The analytical expression of the effort based on the linear behavior of the actuator is given. The identification of the characteristics of the prototype actuator and the principle of position control is performed. A modeling of the actuator is proposed, taking into account the variation of inductance with respect to the position. The closed-loop position control of the actuator is performed by simulation. A controller with integral action and anticipatory action is implemented in order to compensate the effects of disturbing efforts and tracking deviations. Moreover, a magic switch is performed in the controller to avoid overshoots. The results show that the closed-loop response of the actuator is satisfactory

Outcomes indicators and a risk classification system for spinal manipulation under anesthesia: a narrative review and proposal

Abstract Over a period of decades chiropractors have utilized spinal manipulation under anesthesia (SMUA) to treat chronic back and neck pain. As an advanced form of manual therapy, SMUA is reserved for the patient whose condition has proven refractory to office-based manipulation and other modes of conservative care. Historically, the protocols and guidelines put forth by chiropractic MUA proponents have served as the clinical compass for directing MUA practice. With many authors and MUA advocates having focused primarily on anticipated benefit, the published literature contains no resource dedicated to treatment precautions and contraindications. Also absent from current relevant literature is acknowledgement or guidance on the preliminary evidence that may predict poor clinical outcomes with SMUA. This review considers risk and unfavorable outcomes indicators in therapeutic decision making for spinal manipulation under anesthesia. A new risk classification system is proposed that identifies patient safety and quality of care interests for a procedure that remains without higher-level research evidence. A scale which categorizes risk and outcome potential for SMUA is offered for the chiropractic clinician, which aims to elevate the standard of care and improve patient selection through the incorporation of specific indices from existing medical literature