Low-energy total diet replacement intervention in patients with type 2 diabetes mellitus and obesity treated with insulin: a randomized trial

OBJECTIVES: The management of patients with long-standing type 2 diabetes and obesity receiving insulin therapy (IT) is a substantial clinical challenge. Our objective was to examine the effect of a low-energy total diet replacement (TDR) intervention versus standardized dietetic care in patients with long-standing type 2 diabetes and obesity receiving IT. RESEARCH DESIGN AND METHODS: In a prospective randomized controlled trial, 90 participants with type 2 diabetes and obesity receiving IT were assigned to either a low-energy TDR (intervention) or standardized dietetic care (control) in an outpatient setting. The primary outcome was weight loss at 12 months with secondary outcomes including glycemic control, insulin burden and quality of life (QoL). RESULTS: Mean weight loss at 12 months was 9.8 kg (SD 4.9) in the intervention and 5.6 kg (SD 6.1) in the control group (adjusted mean difference -4.3 kg, 95% CI -6.3 to 2.3, p<0.001). IT was discontinued in 39.4% of the intervention group compared with 5.6% of the control group among completers. Insulin requirements fell by 47.3 units (SD 36.4) in the intervention compared with 33.3 units (SD 52.9) in the control (-18.6 units, 95% CI -29.2 to -7.9, p=0.001). Glycated Hemoglobin (HbA1c) fell significantly in the intervention group (4.7 mmol/mol; p=0.02). QoL improved in the intervention group of 11.1 points (SD 21.8) compared with 0.71 points (SD 19.4) in the control (8.6 points, 95% CI 2.0 to 15.2, p=0.01). CONCLUSIONS: Patients with advanced type 2 diabetes and obesity receiving IT achieved greater weight loss using a TDR intervention while also reducing or stopping IT and improving glycemic control and QoL. The TDR approach is a safe treatment option in this challenging patient group but requires maintenance support for long-term success. TRIAL REGISTRATION NUMBER: ISRCTN21335883

Having the Right Tool for the Right Job: Results of an Incentive verses Non-Incentive Weight-loss Program

Article: INTRODUCTION Health promotion or &quot;Wellness&quot; programs have been identified as a means of promoting positive behavior change in the general population, and have become an increasingly attractive value-added benefit in settings such as the worksite, medical and community centers, and universities. As such, one of the most consistently popular choices to effect positive behavior change strategies into a persons lifestyle are weight loss programs. There are several reasons why a weight loss program can provide positive benefits: Weight loss is of great personal interest to many people, thus it can be an attractive fringe benefit at an employment site, Weight loss programs may lessen health expenditures by reducing costs due to weight-related conditions, i.e.; diabetes and hypertension, and, Weight loss may improve overall satisfaction in personal life areas such as self-image and self-esteem. Given these potential benefits, challenges still exist for health professionals obtaining consistent participation and retention by participants engaged in programs such as weight loss. One way to attract people to take part in a program is through the use of incentives. Traditionally, incentives have been offered either up front to encourage sign-up and participation, at various stages of the program to recognize positive behavior change, and/or upon completion of the program. Reports on the use of incentives for participation range from team competitions, money, gifts, and flexible time benefits, among others. Weight loss competitions in the workplace have reported nearly double the attrition and half the weight loss found compared to similar competitions in a clinical setting

Derivation, validation, and comparison of a new prognostic scoring system for acute lower gastrointestinal bleeding

\ua9 2023 The Authors. DEN Open published by John Wiley &amp; Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.Objectives: Lower gastrointestinal bleeding is a common presentation with little data concerning risk factors for adverse outcomes. The aim was to derive and validate a scoring system to stratify risk in lower gastrointestinal bleeding and compare it to the Oakland score. Methods: A total of 2385 consecutive patients (mean age 65 years, 1140 males) were used to derive the score using multivariate logistic regression modeling then internally and externally validated. The Oakland score was applied and area under receiver operating characteristic (AUROC) curves were calculated and compared. A score of &lt;1 was compared with an Oakland score of &lt;9 to assess 30-day rebleeding and mortality rates. Results: Rebleeding was associated with age, inpatient bleeding, syncope, malignancy, tachycardia, hypotension, lower hemoglobin and mortality with age, inpatient bleeding, liver/gastrointestinal disease, tachycardia, and hypotension. The area under the receiver operating characteristic curves was 0.742 for rebleeding and 0.802 for mortality. A score &lt;1 was associated with rebleeding (0.0%–2.2%) and mortality (0%). The Oakland score had a significantly lower area under the receiver operating characteristic curve for rebleeding of 0.687 but not for mortality; 0.757. A score &lt;1 was associated with a lower 30-day rebleeding risk compared to an Oakland score &lt;9 (4/379 vs. 15/355, p = 0.009) but not mortality (0/365 vs. 1/355, p = 0.493). Conclusions: Our score predicts 30-day rebleeding and mortality rate with low scores associated with very low risk. The Aberdeen score is superior to the Oakland score for predicting rebleeding. Prospective evaluation of both scores is required

Comprehensive behavioral testing in the R6/2 mouse model of Huntington's disease shows no benefit from CoQ10 or minocycline

Previous studies of the effects of coenzyme Q10 and minocycline on mouse models of Huntington’s disease have produced conflicting results regarding their efficacy in behavioral tests. Using our recently published best practices for husbandry and testing for mouse models of Huntington’s disease, we report that neither coenzyme Q10 nor minocycline had significant beneficial effects on measures of motor function, general health (open field, rotarod, grip strength, rearing-climbing, body weight and survival) in the R6/2 mouse model. The higher doses of minocycline, on the contrary, reduced survival. We were thus unable to confirm the previously reported benefits for these two drugs, and we discuss potential reasons for these discrepancies, such as the effects of husbandry and nutrition

The Maine Lung Cancer Coalition: A Statewide, Multi-Sector Partnership to Improve Evidence-Based Lung Cancer Prevention & Screening

MLCC has two primary goals: 1. Engage and educate about evidence based lung cancer prevention and screening practices 2. Develop, implement, and evaluate innovative programs to increase access to prevention, screening, and treatment services for all Mainershttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1051/thumbnail.jp

Seasonal Consumptive Demand and Prey Use by Stocked Saugeyes in Ohio Reservoirs

Community structure and species composition may be strongly influenced by predator-prey interactions resulting from and leading to episodes of population abundance or scarcity. We quantified diets of stocked saugeyes (female walleye Sander vitreus × male sauger S. canadensis) and estimated biomass of their primary prey, gizzard shad Dorosoma cepedianum, in three Ohio reservoirs at quarterly intervals during July 2002-July 2003 to determine whether saugeye consumptive demand could exceed the supply of available gizzard shad prey, resulting in a shift to alternative prey. We incorporated water temperature and saugeye diet composition, growth, and mortality into walleye bioenergetics models, which allowed us to compare estimated prey-specific consumption rates by saugeyes with gizzard shad standing stocks estimated with acoustics. Spring and summer were critical seasons. During spring, gizzard shad biomass was low, saugeye consumptive demand was low, and saugeyes consumed primarily alternative prey. During summer, when age-0 gizzard shad became available as prey, saugeyes consumed similar proportions of gizzard shad and alternative prey. Saugeye cumulative consumptive demand in summer was high and approached the gizzard shad standing stock. However, during fall and winter, gizzard shad supply was adequate to support high (fall) or declining (winter) saugeye consumptive demand. Across reservoirs and seasons, saugeyes consumed alternative prey to varying degrees, primarily sunfishes Lepomis spp., yellow perch Perca flavescens, logperch Percina caprodes, and minnows Pimephales spp. Seasonal asynchrony between saugeye consumptive demand and gizzard shad biomass during spring and summer indicated that a saugeye population with high survival, growth, and consumptive demand will opportunistically increase use of prey other than gizzard shad. The manner in which saugeye predation quantitatively influences these prey species could not be assessed. However, overexploitation of gizzard shad prey appears to be unlikely at current saugeye population sizes, particularly considering the opportunistic use of alternative prey and the high reproductive potential of gizzard shad.Funding for this research was provided by the Ohio Department of Natural Resources, Division of Wildlife; Federal Aid in Sport Fish Restoration Project F-69-P, Fish Management in Ohio; and the Department of Evolution, Ecology, and Organismal Biology at The Ohio State University

Surgical Education International surgical clerkship rotation: perceptions and academic performance

Abstract BACKGROUND: Concerns about international training experiences in medical school curricula include the effect on student learning. We studied the educational effect of an international elective integrated into a traditional third-year (M3) surgical clerkship. METHODS: A 1-week surgical elective in Haiti was available to M3 students during the conventional 8-week surgical clerkship each year for the 4 academic years 2008 to 2011. The authors collected student and surgeon perceptions of the elective using a mixed-methods web-based survey. Statistical analysis compared the academic performance of participating M3s relative to nonparticipating peers. RESULTS: Twenty-eight (100%) students (41 trip weeks) and 3 (75%) surgeons responded. Twentyfive (89%) students believed the elective provided appropriate clinical training. Surgeon responses were consistent with students&apos; reported perceptions. Strengths included unique clinical experiences and close interactions with faculty. Criticisms included recurring overwhelming clinical responsibilities and lack of local provider involvement. Academic performance of participants versus nonparticipants in the same clerkship term were statistically insignificant. CONCLUSIONS: This study demonstrates the feasibility of integrating global health experiences into traditional medical student clinical curricula. The effects on less tangible attributes such as leadership skills, fostering teamwork, and cultural competency require future investigation

‘Sons of athelings given to the earth’: Infant Mortality within Anglo-Saxon Mortuary Geography

FOR 20 OR MORE YEARS early Anglo-Saxon archaeologists have believed children are underrepresented in the cemetery evidence. They conclude that excavation misses small bones, that previous attitudes to reporting overlook the very young, or that infants and children were buried elsewhere. This is all well and good, but we must be careful of oversimplifying compound social and cultural responses to childhood and infant mortality. Previous approaches have offered methodological quandaries in the face of this under-representation. However, proportionally more infants were placed in large cemeteries and sometimes in specific zones. This trend is statistically significant and is therefore unlikely to result entirely from preservation or excavation problems. Early medieval cemeteries were part of regional mortuary geographies and provided places to stage events that promoted social cohesion across kinship systems extending over tribal territories. This paper argues that patterns in early Anglo-Saxon infant burial were the result of female mobility. Many women probably travelled locally to marry in a union which reinforced existing social networks. For an expectant mother, however, the safest place to give birth was with experience women in her maternal home. Infant identities were affected by personal and legal association with their mother’s parental kindred, so when an infant died in childbirth or months and years later, it was their mother’s identity which dictated burial location. As a result, cemeteries central to tribal identities became places to bury the sons and daughters of a regional tribal aristocracy

Multicenter experience from the UK and Ireland of use of lumen-apposing metal stent for transluminal drainage of pancreatic fluid collections

Background and study aims: Pancreatic fluid collection (PFC) is a common complication of pancreatitis for which endoscopic ultrasound-guided drainage is first-line treatment. A new single-device, lumen-apposing, covered self-expanding metal stent (LAMS) has been licensed for PFC drainage. We therefore present our multicenter experience with the LAMS for PFC drainage in a multicenter prospective case series to assess success and complication rates. Patients and methods: All adult patients from 11 tertiary centers who had LAMS placement for PFC from July 2015 to July 2016 were included. Data including indications, technical success, clinical success, collection resolution, stent removal, early and late adverse events (AEs), mortality and recurrence at 6 months were collected. Results: 116 patients, median age 52.5 years (range 16 – 80) and 67 % male, were treated with a single LAMS in each case. The indication was walled off necrosis (WON) in 70 and pseudocyst in 46. Median size of the PFC was 11 cm (5 – 21 cm) and the estimated median necrotic volume in WON was 30 % (5 % – 90 %). Stent insertion was technically successful in 115 (99.1 %) and clinically successful in 109 (94 %). Early serious AEs (SAEs): n = 7 sepsis, n = 1 stent blockage with food, n = 1 stent migration requiring laparotomy, n = 1 stent dislodgement and n = 1 bleeding requiring emboliZation. Late AEs: n = 1 buried stent and n = 1 esophageal fistula. Non-procedure-related deaths: n = 3 (2.5 %). Conclusion: This multicenter case series demonstrates that use of the new LAMS is feasible, effective and relatively safe in draining PFC with a technical success rate of 99 % and cumulative SAE rate of 11.2 %