Quality of Life Following Massive Weight Loss and Body Contouring Surgery: an Exploratory Study.

Reconstructive surgery is a major growth intervention for body improvement, enhancing appearance and psychological well-being following massive weight loss. The psychosocial benefits include greater capacity for social networking, lower scores of body uneasiness, body image satisfaction, improved mental well-being and physical function. However little collective evidence exists regarding the impact of body contouring on patients Quality of Life (QoL) and there is a lack of systematic review and randomised controlled trials (RCTs) with a scarcity of high level evidence. The purpose of this exploratory study was to explore the QoL perceptions, experiences and outcomes of patients who have undergone body contouring following significant weight loss and to explore the relevance and potential utility of the Obesity Psychosocial State Questionnaire (OPSQ) as a valuable QoL outcomes measuring tool for use in clinical research. Data were collected in a community setting in the south of England via digitally recorded semi-structured interviews with twenty participants (18 women and 2 men), who also self-completed the Obesity Psychosocial State Questionnaire (OBSQ). Medical notes were reviewed retrospectively to gather data about body mass index (BMI), co-morbidities, eating profiles/lifestyle, uptake of bariatric surgery and type/number of body contouring procedures undergone. A thematic approach was adopted to analyse the interviews and medical record data, supported by Nvivo7 qualitative software, and a statistical approach to analyse the questionnaire data, supported by Statistical Analysis Software. The results provide unique glimpses of the body contouring interventions for empowering and facilitating a ‘transformation’, a ‘new identity’, a ‘new start’ in life, improved physical function, greater body image satisfaction, a stronger sense of well-being and an improved quality of life. A few of the participants who reported that their weight gain was powered by childhood traumas (abuse, neglect, abandonment) continued to struggle for ‘normality’, with fragile eating control and addictive traits. Eating disordered trauma survivors mentioned post traumatic flashbacks and underlying conflicts that triggered powerlessness and emotional eating. The emotional flooding with psychological and body related memories did not appear to be fully processed or released, despite counselling and binge eating programmes. The participants also confirmed the value of the OBSQ, whilst highlighting its limited set of three questions on feelings of self-efficacy towards eating habits. The study findings show that body contouring optimises quality of life with significant improvement in physical function, body image, mental health and psychosocial function. Further research is warranted to extent the scope of the findings within a sample drawn from multiple treatment centres. This would valuably: • Explore gender, ethnic and cultural variables, important to optimising quality of life. • Clarify distinguishing features between short and long-term QoL outcomes. • Lead to the development of national policy and guidelines on reconstructive ‘body contouring’ surgery following massive weight loss, in line with the call from the British Association for Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) A future multi-centre collaborative study could employ the OBSQ, supplemented by an additional tool to explore factors that influence eating habits such as the three factor eating questionnaire (such as the TFEQ-R1 21 Scale). Such research could enhance understanding of quality of life and long-term weight management

NR2A- and NR2B-containing NMDA Receptors in the Prelimbic Medial Prefrontal Cortex Differentially Mediate Trace, Delay, and Contextual Fear Conditioning

Activation of N-methyl-D-aspartate receptors (NMDAR) in the prelimbic medial prefrontal cortex (PL mPFC) is necessary for the acquisition of both trace and contextual fear memories, but it is not known how specific NR2 subunits support each association. The NR2B subunit confers unique properties to the NMDAR and may differentially regulate these two fear memories. Here we show that NR2A-containing NMDARs mediate trace, delay, and contextual fear memories, but NR2B-containing NMDARs are required only for trace conditioning, consistent with a role for PL mPFC in working memory

Prefrontal Activity Links Nonoverlapping Events in Memory

The medial prefrontal cortex (mPFC) plays an important role in memory. By maintaining a working memory buffer, neurons in prelimbic (PL) mPFC may selectively contribute to learning associations between stimuli that are separated in time, as in trace fear conditioning (TFC). Until now, evidence for this bridging role was largely descriptive. Here we used optogenetics to silence neurons in the PL mPFC of rats during learning in TFC. Memory formation was prevented when mPFC was silenced specifically during the interval separating the cue and shock. Our results provide support for a working memory function for these cells and indicate that associating two noncontiguous stimuli requires bridging activity in PL mPFC

Sympathetic inhibition of accommodation after sustained nearwork in subjects with myopia and emmetropia

PURPOSE. The purposes of the present study were to assess the effect of a sympathetic inhibitory pharmacologic agent, timolol maleate, on the magnitude of nearwork-induced transient myopia (NITM) and its decay in different refractive groups for an extended near task duration and to determine the proportion of the young adult population manifesting effective sympathetic access under naturalistic closed-loop viewing conditions. METHODS. Ten subjects with emmetropia and 10 with myopia were tested. They read binocularly for 1 hour at a distance of 35 to 40 cm. NITM was calculated as the difference in distance refractive state after task as compared with before task immediately after reading. All subjects received timolol maleate to block the sympathetic nervous system and betaxolol as a control agent in independent test sessions separated by at least 3 days. Forty minutes after drug instillation, the NITM measurement procedure was repeated. RESULTS. Initial NITM magnitude was larger in subjects with myopia than in subjects with emmetropia before and after timolol instillation. Furthermore, NITM magnitude in subjects with sympathetic access was increased after timolol instillation. In contrast, with the control agent betaxolol, there was no increase. NITM decay duration to baseline was increased after timolol instillation in the subjects with myopia only. Only 15% of the subjects (n = 3 subjects with myopia) demonstrated effective and significant access to sympathetic facility. CONCLUSIONS. Subjects with myopia demonstrated an increase in decay duration with timolol, thus suggesting impaired sympathetic inhibition of accommodation. This may be a precursor for myopia progression in some persons

Political trials and the suppression of popular radicalism in England, 1799-1820

This chapter examines the decision-making process between the Home Office and the government’s law officers in prosecuting individuals for sedition and treason in the period 1799–1820. The term state trial suggests a more centralised and government-led repression of popular radicalism than the process was in practice. Provincial reformers also faced the complex layers of their local justice system, which was more loyalist, committed to stamping out political radicalism. The trial of the “Thirty Eight” Manchester radicals in June 1812 demonstrates the mutable definitions of treason, sedition and processes of justice in the theatre of the court.Peer reviewe

The application of modelling techniques to identify material properties for cost effective and high quality profiling.

Zinc and organically coated strip steels are products of Corus Colors, which are supplied to the roll forming industry and profiled for a variety of applications, including building cladding and composite floor decking. Many profile designs include complex roll geometry which promotes intense deformation and as a consequence can create a number of defects within the steel strip. Cracking, wavy edges and spring-back are three of the more common reoccurring problems. To overcome such defects within the production line when they occur, simple procedures are carried out by experienced line operators. One method is to adjust the clearance between the upper and lower rolls of the problematic roll stand on either the outboard or inboard side of the production line. In recent years the potential of Finite Element Modelling (FEM) has been realised for the simulation of such processes in both 2D and 3D. Due to advances in computer graphics and processing, the use of 3D FEM packages to simulate the effects on material properties within a roll forming line is becoming an area of high interest within the profiling industry. Studies in this report have focused on using ABAQUS FEM software to simulate in 3D, profiling stands within a production line used to create a trapezoidal profile using HPS200 (Colorcoat) steel. Particular attention was given to the variables set during creation of the simulation, such as friction coefficients, roll clearance and speed of the rotating rolls used to transport the strip. A plant trial was conducted to determine the profile measurements of the strip at different stages of the process which were then used to perform a validation with the simulation model