Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults.

BACKGROUND: Obesity is a global public health threat. The transtheoretical stages of change (TTM SOC) model has long been considered a useful interventional approach in lifestyle modification programmes, but its effectiveness in producing sustainable weight loss in overweight and obese individuals has been found to vary considerably.  OBJECTIVES: To assess the effectiveness of dietary intervention or physical activity interventions, or both, and other interventions based on the transtheoretical model (TTM) stages of change (SOC) to produce sustainable (one year and longer) weight loss in overweight and obese adults. SEARCH METHODS: Studies were obtained from searches of multiple electronic bibliographic databases. We searched The Cochrane Library, MEDLINE, EMBASE and PsycINFO. The date of the last search, for all databases, was 17 December 2013. SELECTION CRITERIA: Trials were included if they fulfilled the criteria of randomised controlled clinical trials (RCTs) using the TTM SOC as a model, that is a theoretical framework or guideline in designing lifestyle modification strategies, mainly dietary and physical activity interventions, versus a comparison intervention of usual care; one of the outcome measures of the study was weight loss, measured as change in weight or body mass index (BMI); participants were overweight or obese adults only; and the intervention was delivered by healthcare professionals or trained lay people at the hospital and community level, including at home. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted the data, assessed studies for risk of bias and evaluated overall study quality according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). We resolved disagreements by discussion or consultation with a third party. A narrative, descriptive analysis was conducted for the systematic review. MAIN RESULTS: A total of three studies met the inclusion criteria, allocating 2971 participants to the intervention and control groups. The total number of participants randomised to the intervention groups was 1467, whilst 1504 were randomised to the control groups. The length of intervention was 9, 12 and 24 months in the different trials. The use of TTM SOC in combination with diet or physical activity, or both, and other interventions in the included studies produced inconclusive evidence that TTM SOC interventions led to sustained weight loss (the mean difference between intervention and control groups varied from 2.1 kg to 0.2 kg at 24 months; 2971 participants; 3 trials; low quality evidence). Following application of TTM SOC there were improvements in physical activity and dietary habits, such as increased exercise duration and frequency, reduced dietary fat intake and increased fruit and vegetable consumption (very low quality evidence). Weight gain was reported as an adverse event in one of the included trials. None of the trials reported health-related quality of life, morbidity, or economic costs as outcomes. The small number of studies and their variable methodological quality limit the applicability of the findings to clinical practice. The main limitations include inadequate reporting of outcomes and the methods for allocation, randomisation and blinding; extensive use of self-reported measures to estimate the effects of interventions on a number of outcomes, including weight loss, dietary consumption and physical activity levels; and insufficient assessment of sustainability due to lack of post-intervention assessments. AUTHORS' CONCLUSIONS: The evidence to support the use of TTM SOC in weight loss interventions is limited by risk of bias and imprecision, not allowing firm conclusions to be drawn. When combined with diet or physical activity, or both, and other interventions we found very low quality evidence that it might lead to better dietary and physical activity habits. This systematic review highlights the need for well-designed RCTs that apply the principles of the TTM SOC appropriately to produce conclusive evidence about the effect of TTM SOC lifestyle interventions on weight loss and other health outcomes

Head-to-head trials of antibiotics for bronchiectasis

Background The diagnosis of bronchiectasis is defined by abnormal dilation of the airways related to a pathological mechanism of progressive airway destruction that is due to a 'vicious cycle' of recurrent bacterial infection, inflammatory mediator release, airway damage, and subsequent further infection. Antibiotics are the main treatment option for reducing bacterial burden in people with exacerbations of bronchiectasis and for longer‐term eradication, but their use is tempered against potential adverse effects and concerns regarding antibiotic resistance. The comparative effectiveness, cost‐effectiveness, and safety of different antibiotics have been highlighted as important issues, but currently little evidence is available to help resolve uncertainty on these questions. Objectives To evaluate the comparative effects of different antibiotics in the treatment of adults and children with bronchiectasis. Search methods We identified randomised controlled trials (RCTs) through searches of the Cochrane Airways Group Register of trials and online trials registries, run 30 April 2018. We augmented these with searches of the reference lists of published studies. Selection criteria We included RCTs reported as full‐text articles, those published as abstracts only, and unpublished data. We included adults and children (younger than 18 years) with a diagnosis of bronchiectasis by bronchography or high‐resolution computed tomography who reported daily signs and symptoms, such as cough, sputum production, or haemoptysis, and those with recurrent episodes of chest infection; we included studies that compared one antibiotic versus another when they were administered by the same delivery method. Data collection and analysis Two review authors independently assessed trial selection, data extraction, and risk of bias. We assessed overall quality of the evidence using GRADE criteria. We made efforts to collect missing data from trial authors. We have presented results with their 95% confidence intervals (CIs) as mean differences (MDs) or odds ratios (ORs). Main results Four randomised trials were eligible for inclusion in this systematic review ‐ two studies with 83 adults comparing fluoroquinolones with β‐lactams and two studies with 55 adults comparing aminoglycosides with polymyxins. None of the included studies reported information on exacerbations ‐ one of our primary outcomes. Included studies reported no serious adverse events ‐ another of our primary outcomes ‐ and no deaths. We graded this evidence as low or very low quality. Included studies did not report quality of life. Comparison between fluoroquinolones and β‐lactams (amoxicillin) showed fewer treatment failures in the fluoroquinolone group than in the amoxicillin group (OR 0.07, 95% CI 0.01 to 0.32; low‐quality evidence) after 7 to 10 days of therapy. Researchers reported that Pseudomonas aeruginosa infection was eradicated in more participants treated with fluoroquinolones (Peto OR 20.09, 95% CI 2.83 to 142.59; low‐quality evidence) but provided no evidence of differences in the numbers of participants showing improvement in sputum purulence (OR 2.35, 95% CI 0.96 to 5.72; very low‐quality evidence). Study authors presented no evidence of benefit in relation to forced expiratory volume in one second (FEV₁). The two studies that compared polymyxins versus aminoglycosides described no clear differences between groups in the proportion of participants with P aeruginosa eradication (OR 1.40. 95% CI 0.36 to 5.35; very low‐quality evidence) or improvement in sputum purulence (OR 0.16, 95% CI 0.01 to 3.85; very low‐quality evidence). The evidence for changes in FEV₁ was inconclusive. Two of three trials reported adverse events but did not report the proportion of participants experiencing one or more adverse events, so we were unable to interpret the information. Authors' conclusions Limited low‐quality evidence favours short‐term oral fluoroquinolones over beta‐lactam antibiotics for patients hospitalised with exacerbations. Very low‐quality evidence suggests no benefit from inhaled aminoglycosides verus polymyxins. RCTs have presented no evidence comparing other modes of delivery for each of these comparisons, and no RCTs have included children. Overall, current evidence from a limited number of head‐to‐head trials in adults or children with bronchiectasis is insufficient to guide the selection of antibiotics for short‐term or long‐term therapy. More research on this topic is needed

Design of an 8-40 GHz Antenna for the Wideband Instrument for Snow Measurements (WISM)

Measurement of land surface snow remains a significant challenge in the remote sensing arena. Developing the tools needed to remotely measure Snow Water Equivalent (SWE) is an important priority. The Wideband Instrument for Snow Measurements (WISM) is being developed to address this need. WISM is an airborne instrument comprised of a dual-frequency (X- and Ku-bands) Synthetic Aperture Radar (SAR) and dual-frequency (K- and Ka-bands) radiometer. A unique feature of this instrument is that all measurement bands share a common antenna aperture consisting of an array feed reflector that covers the entire bandwidth. This paper covers the design and fabrication of the wideband array feed which is based on tightly coupled dipole arrays. Implementation using a relatively new multi-layer microfabrication process results in a small, 6x6 element, dual-linear polarized array with beamformer that operates from 8 to 40 gigahertz

Antenna Characterization for the Wideband Instrument for Snow Measurements (WISM)

Experimental characterization of the antenna for the Wideband Instrument for Snow Measurement (WISM) under development for the NASA Earth Science Technology Office (ESTO) Instrument Incubator Program (IIP), is discussed. A current sheet antenna, consisting of a small, 6x6 element, dual-linear polarized array with integrated beamformer, feeds an offset parabolic reflector, enabling WISM operation over an 8 to 40 GHz frequency band. An overview of the test program implemented for both the feed and the reflector antenna is given along with select results for specific frequencies utilized by the radar and radiometric sensors of the WISM

Antenna Characterization for the Wideband Instrument for Snow Measurements

Experimental characterization of the antenna for the Wideband Instrument for Snow Measurements (WISM) under development for the NASA Earth Science Technology Office (ESTO) Instrument Incubator Program (IIP), is discussed. A current sheet antenna, consisting of a small, 6x6 element, dual-linear polarized array with integrated beamformer, feeds an offset parabolic reflector, enabling WISM operation over an 8 to 40 GHz frequency band. An overview of the test program implemented for both the feed and the reflector antenna is given along with select results for specific frequencies utilized by the radar and radiometric sensors of the WISM

Design of an 8-40 GHz Antenna for the Wideband Instrument for Snow Measurements (WISM)

This poster describes the implementation of a 6x6 element, dual linear polarized array with beamformer that operates from about 8-40 GHz. It is implemented using a relatively new multi-layer microfabrication process. The beamformer includes baluns that feed dual-polarized differential antenna elements and reactive splitters that cover the full frequency range of operation. This fixed beam array (FBA) serves as the feed for a multi-band instrument designed to measure snow water equivalent (SWE) from an airborne platform known as the Wideband Instrument for Snow Measurements (WISM)

Antenna Near-Field Probe Station Scanner

A miniaturized antenna system is characterized non-destructively through the use of a scanner that measures its near-field radiated power performance. When taking measurements, the scanner can be moved linearly along the x, y and z axis, as well as rotationally relative to the antenna. The data obtained from the characterization are processed to determine the far-field properties of the system and to optimize the system. Each antenna is excited using a probe station system while a scanning probe scans the space above the antenna to measure the near field signals. Upon completion of the scan, the near-field patterns are transformed into far-field patterns. Along with taking data, this system also allows for extensive graphing and analysis of both the near-field and far-field data. The details of the probe station as well as the procedures for setting up a test, conducting a test, and analyzing the resulting data are also described

Macrolide antibiotics for non-cystic fibrosis bronchiectasis

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the impact of macrolide antibiotics in the treatment of adults and children with non-cystic fibrosis bronchiectasis

Small X-Band Oscillator Antennas

A small, segmented microstrip patch antenna integrated with an X-band feedback oscillator on a high-permittivity substrate has been built and tested. This oscillator antenna is a prototype for demonstrating the feasibility of such devices as compact, low-power-consumption building blocks of advanced, lightweight, phased antenna arrays that would generate steerable beams for communication and remotesensing applications

Protocol for the SAFEST review: the Shock-Absorbing Flooring Effectiveness SysTematic review including older adults and staff in hospitals and care homes.

INTRODUCTION: Falls in hospitals and care homes are a major issue of international concern. Inpatient falls are the most commonly reported safety incident in the UK's National Health Service (NHS), costing the NHS £630 million a year. Injurious falls are particularly life-limiting and costly. There is a growing body of evidence on shock-absorbing flooring for fall-related injury prevention; however, no systematic review exists to inform practice. METHODS AND ANALYSIS: We will systematically identify, appraise and summarise studies investigating the clinical and cost-effectiveness, and experiences of shock-absorbing flooring in hospitals and care homes. Our search will build on an extensive search conducted by a scoping review (inception to May 2016). We will search electronic databases (AgeLine, CINAHL, MEDLINE, NHS Economic Evaluation Database, Scopus and Web of Science; May 2016-present), trial registries and grey literature. We will conduct backward and forward citation searches of included studies, and liaise with study researchers. We will evaluate the influence of floors on fall-related injuries, falls and staff work-related injuries through randomised and non-randomised studies, consider economic and qualitative evidence, and implementation factors. We will consider risk of bias, assess heterogeneity and explore potential effect modifiers via subgroup analyses and sensitivity analyses. Where appropriate we will combine studies through meta-analysis. We will use the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach to evaluate the quality of evidence and present the results using summary of findings tables, and adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. ETHICS AND DISSEMINATION: We will follow the ethical principles of systematic review conduct, by attending to publication ethics, transparency and rigour. Our dissemination plan includes peer-reviewed publication, presentations, press release, stakeholder symposium, patient video and targeted knowledge-to-action reports. This review will inform decision-making around falls management in care settings and identify important directions for future research. PROSPERO REGISTRATION NUMBER: CRD42019118834