Is phentermine/topiramate ER with lifestyle modifications effective in achieving weight loss in obese patients with comorbidities?

Objective: The objective of this selective EBM review is to determine whether or not “Is phentermine/topiramate ER with lifestyle modifications effective in achieving weight loss in obese patients with comorbidities?” Study Design: A systematic review of three placebo-controlled randomized controlled trials (RCTs) published in English in 2012 or after. Data Sources: All three studies were found by searching PubMed and were published in peer-reviewed journals. The articles were selected based on ability to answer the proposed question. Outcome Measured: Percent weight loss was the outcome measured in all three studies. This was measured based on mean percent weight loss from baseline at various weekly intervals. Results: Aronne, et al, conducted a double-blind RCT that showed phentermine/topiramate (PHEN/TPM ER) 15/92 mg produced greater percent weight loss at every 4 weeks than the placebo group (p \u3c 0.05) with LS mean percent weight loss of -11.63 compared to placebo at -2.28 for mITT analysis. 8 The ITT-LOCF analysis showed LS mean percent weight loss of -1.71 for the placebo and -9.21 for PHEN/TPM ER (p \u3c 0.05). 8 The Winslow, et al double-blind RCT found a LS mean percent weight loss from baseline of -10.3% (standard error 1.17) for PHEN/TPM ER and -4.2% (standard error 1.15) for placebo (p = 0.0006). 9 Garvey, et al’s double-blind RCT showed that PHEN/TPM ER produced a LS mean percent weight loss of 12.1% and the placebo group only achieved 2.5% (ITT-MI; p = 0.0001). 10 Conclusion: The three studies in this review found PHEN/TPM ER to produce greater weight loss that was statistically significant when compared to placebo. This demonstrates the utility of PHEN/TPM ER in helping patients achieve weight loss and subsequently reduce the prevalence or risk of obesity-related comorbidities. Further research should be conducted to assess the role lifestyle modifications play in the success of PHEN/TPM ER and to determine its effectiveness in adolescents

TB123: Experimental Application of B.t.i. for Larval Black Fly Control: Persistance and Downstream Carry, Efficacy, Impact on Non-target Invertebrates and Fish Feeding

In the summer of 1985 a field experiment was conducted in the Sugarloaf area of Maine on the use of B.t.i. to reduce the numbers of black fly larvae in the Carrabassett River and a tributary stream. The objectives were to determine the rate of application necessary to produce an acceptable reduction in black fly larvae, to study the fate and persistence of B.t.i. in a stream following application, to determine the impact of B.t.i. on the abundance and drift of non-target stream insects and on the feeding success and diet composition of fishes in the treated streams.https://digitalcommons.library.umaine.edu/aes_techbulletin/1083/thumbnail.jp

Exploring the role of pain as an early predictor of category 2 pressure ulcers: a prospective cohort study

Objective To explore pressure area related pain as a predictor of category ≥2 pressure ulcer (PU) development. Design Multicentre prospective cohort study. Setting UK hospital and community settings. Participants inclusion Consenting acutely ill patients aged ≥18 years, defined as high risk (Braden bedfast/chairfast AND completely immobile/very limited mobility; pressure area related pain or; category 1 PU). Exclusion Patients too unwell, unable to report pain, 2 or more category ≥2 PUs. Follow-up Twice weekly for 30 days. Primary and secondary outcome measures Development and time to development of one or more category ≥2 PUs. Results Of 3819 screened, 1266 were eligible, 634 patients were recruited, 32 lost to follow-up, providing a 602 analysis population. 152 (25.2%) developed one or more category ≥2 PUs. 464 (77.1%) patients reported pressure area related pain on a healthy, altered or category 1 skin site of whom 130 (28.0%) developed a category ≥2 PU compared with 22 (15.9%) of those without pain. Full stepwise variable selection was used throughout the analyses. (1) Multivariable logistic regression model to assess 9 a priori factors: presence of category 1 PU (OR=3.25, 95% CI (2.17 to 4.86), p<0.0001), alterations to intact skin (OR=1.98, 95% CI (1.30 to 3.00), p=0.0014), pressure area related pain (OR=1.56, 95% CI (0.93 to 2.63), p=0.0931). (2) Multivariable logistic regression model to account for overdispersion: presence of category 1 PU (OR=3.20, 95% CI (2.11 to 4.85), p<0.0001), alterations to intact skin (OR=1.90, 95% CI (1.24 to 2.91), p=0.0032), pressure area related pain (OR=1.85, 95% CI (1.07 to 3.20), p=0.0271), pre-existing category 2 PU (OR=2.09, 95% CI (1.35 to 3.23), p=0.0009), presence of chronic wound (OR=1.66, 95% CI (1.06 to 2.62), p=0.0277), Braden activity (p=0.0476). (3) Accelerated failure time model: presence of category 1 PU (AF=2.32, 95% CI (1.73 to 3.12), p<0.0001), pressure area related pain (AF=2.28, 95% CI (1.59 to 3.27), p<0.0001). (4) 2-level random-intercept logistic regression model: skin status which comprised 2 levels (versus healthy skin); alterations to intact skin (OR=4.65, 95% CI (3.01 to 7.18), p<0.0001), presence of category 1 PU (OR=17.30, 95% CI (11.09 to 27.00), p<0.0001) and pressure area related pain (OR=2.25, 95% CI (1.53 to 3.29), p<0.0001). Conclusions This is the first study to assess pain as a predictor of category ≥2 PU development. In all 4 models, pain emerged as a risk factor associated with an increased probability of category ≥2 PU development

Henry Beston Correspondence

Entries include a brief biography, a photographic image of Beston from a newspaper clipping, hand written letters on Chimney Farm stationery, a newspaper review clipping, hand written research questions, a personal postcard with the photographic image of Hatch\u27s wood carving of the seal of the State of Maine, and a book jacke

TEAM EMOTIONAL INTELLIGENCE: LINKING TEAM SOCIAL AND EMOTIONAL ENVIRONMENT TO TEAM EFFECTIVENESS

Work teams are labelled “emotional incubators” because of the ubiquitous emotion generated as team members work together. Although this emotion affects team processes and effectiveness, little theory or research has provided practical information about how teams can manage emotion so that it supports, rather than hinders, team effectiveness. To solve this problem, we draw on social psychological theory suggesting that emotion in teams primarily comes from whether team members’ social and emotional needs (i.e., belonging, shared understanding and control) are satisfied by the team. We then present a study conducted with teams in six U.S. based (four global) companies, testing the relationship between six emotionally intelligent team norms aimed at satisfying team member needs. We hypothesize that incorporating these six norms will lead to high levels of team effectiveness through their influence on the emergence of a productive social and emotional environment (i.e., team psychological safety and team efficacy). Hypotheses are primarily supported. Our study contributes to current knowledge about human social and emotional needs and the influence of emotion and its management on team effectiveness

TEAM EMOTIONAL INTELLIGENCE: LINKING TEAM SOCIAL AND EMOTIONAL ENVIRONMENT TO TEAM EFFECTIVENESS

Work teams are labelled “emotional incubators” because of the ubiquitous emotion generated as team members work together. Although this emotion affects team processes and effectiveness, little theory or research has provided practical information about how teams can manage emotion so that it supports, rather than hinders, team effectiveness. To solve this problem, we draw on social psychological theory suggesting that emotion in teams primarily comes from whether team members’ social and emotional needs (i.e., belonging, shared understanding and control) are satisfied by the team. We then present a study conducted with teams in six U.S. based (four global) companies, testing the relationship between six emotionally intelligent team norms aimed at satisfying team member needs. We hypothesize that incorporating these six norms will lead to high levels of team effectiveness through their influence on the emergence of a productive social and emotional environment (i.e., team psychological safety and team efficacy). Hypotheses are primarily supported. Our study contributes to current knowledge about human social and emotional needs and the influence of emotion and its management on team effectiveness

The challenges and affordances of online participatory workshops in the context of young people's everyday climate crisis activism: insights from facilitators

Participatory workshops can provide an equitable way of working with diverse communities to co-produce new knowledge and understanding in the context of young people’s everyday climate crisis activism. Drawing on data from interviews with seven facilitators, we consider the specific affordances and challenges provided by participatory workshops that are held online with groups including young people and teachers. We highlight that the online format can provide a powerful methodological tool for co-production, community building and developing constructive intergenerational dialogue. Although online workshops can include diverse voices, barriers and challenges remain when seeking to reduce the persistent under-representation of some groups

Comparing alternating pressure mattresses and high-specification foam mattresses to prevent pressure ulcers in high-risk patients: the PRESSURE 2 RCT

Background: Pressure ulcers (PUs) are a burden to patients, carers and health-care providers. Specialist mattresses minimise the intensity and duration of pressure on vulnerable skin sites in at-risk patients. Primary objective: Time to developing a new PU of category ≥ 2 in patients using an alternating pressure mattress (APM) compared with a high-specification foam mattress (HSFM). Design: A multicentre, Phase III, open, prospective, planned as an adaptive double-triangular group sequential, parallel-group, randomised controlled trial with an a priori sample size of 2954 participants. Randomisation used minimisation (incorporating a random element). Setting: The trial was set in 42 secondary and community inpatient facilities in the UK. Participants: Adult inpatients with evidence of acute illness and at a high risk of PU development. Interventions and follow-up: APM or HSFM – the treatment phase lasted a maximum of 60 days; the final 30 days were post-treatment follow-up. Main outcome measures: Time to event. Results: From August 2013 to November 2016, 2029 participants were randomised to receive either APM (n = 1016) or HSFM (n = 1013). Primary end point – 30-day final follow-up: of the 2029 participants in the intention-to-treat population, 160 (7.9%) developed a new PU of category ≥ 2. There was insufficient evidence of a difference between groups for time to new PU of category ≥ 2 [Fine and Gray model HR 0.76, 95% confidence interval (CI) 0.56 to 1.04; exact p-value of 0.0890 and 2% absolute difference]. Treatment phase sensitivity analysis: 132 (6.5%) participants developed a new PU of category ≥ 2 between randomisation and end of treatment phase. There was a statistically significant difference in the treatment phase time-to-event sensitivity analysis (Fine and Gray model HR 0.66, 95% CI 0.46 to 0.93; p = 0.0176 and 2.6% absolute difference). Secondary end points – 30-day final follow-up: new PUs of category ≥ 1 developed in 350 (17.2%) participants, with no evidence of a difference between mattress groups in time to PU development, (Fine and Gray model HR 0.83, 95% CI 0.67 to 1.02; p-value = 0.0733 and absolute difference 3.1%). New PUs of category ≥ 3 developed in 32 (1.6%) participants with insufficient evidence of a difference between mattress groups in time to PU development (Fine and Gray model HR 0.81, 95% CI 0.40 to 1.62; p = 0.5530 and absolute difference 0.4%). Of the 145 pre-existing PUs of category 2, 89 (61.4%) healed – there was insufficient evidence of a difference in time to healing (Fine and Gray model HR 1.12, 95% CI 0.74 to 1.68; p = 0.6122 and absolute difference 2.9%). Health economics – the within-trial and long-term analysis showed APM to be cost-effective compared with HSFM; however, the difference in costs models are small and the quality-adjusted life-year gains are very small. There were no safety concerns. Blinded photography substudy – the reliability of central blinded review compared with clinical assessment for PUs of category ≥ 2 was ‘very good’ (kappa statistic 0.82, prevalence- and bias-adjusted kappa 0.82). Quality-of-life substudy – the Pressure Ulcer Quality of Life – Prevention (PU-QoL-P) instrument meets the established criteria for reliability, construct validity and responsiveness. Limitations: A lower than anticipated event rate. Conclusions: In acutely ill inpatients who are bedfast/chairfast and/or have a category 1 PU and/or localised skin pain, APMs confer a small treatment phase benefit that is diminished over time. Overall, the APM patient compliance, very low PU incidence rate observed and small differences between mattresses indicate the need for improved indicators for targeting of APMs and individualised decision-making. Decisions should take into account skin status, patient preferences (movement ability and rehabilitation needs) and the presence of factors that may be potentially modifiable through APM allocation, including being completely immobile, having nutritional deficits, lacking capacity and/or having altered skin/category 1 PU. Future work: Explore the relationship between mental capacity, levels of independent movement, repositioning and PU development. Explore ‘what works for whom and in what circumstances’. Trial registration: Current Controlled Trials ISRCTN01151335. Funding: This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 52. See the NIHR Journals Library website for further project information

Developing a pressure ulcer risk factor minimum data set and risk assessment framework

AIM: To agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework.BACKGROUND: A recent systematic review identified the need for a pressure ulcer risk factor Minimum Data Set and development and validation of an evidenced-based pressure ulcer Risk Assessment Framework. This was undertaken through the Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research and incorporates five phases. This article reports phase two, a consensus study.DESIGN: Consensus study.METHOD: A modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. This incorporated an expert group, review of the evidence and the views of a Patient and Public Involvement service user group. Data were collected December 2010-December 2011.FINDINGS: The risk factors and assessment items of the Minimum Data Set (including immobility, pressure ulcer and skin status, perfusion, diabetes, skin moisture, sensory perception and nutrition) were agreed. In addition, a draft Risk Assessment Framework incorporating all Minimum Data Set items was developed, comprising a two stage assessment process (screening and detailed full assessment) and decision pathways.CONCLUSION: The draft Risk Assessment Framework will undergo further design and pre-testing with clinical nurses to assess and improve its usability. It will then be evaluated in clinical practice to assess its validity and reliability. The Minimum Data Set could be used in future for large scale risk factor studies informing refinement of the Risk Assessment Framework