Evaluation of a multidisciplinary Tier 3 weight management service for adults with morbid obesity, or obesity and comorbidities, based in primary care

A multidisciplinary Tier 3 weight management service in primary care recruited patients with a body mass index ≥40 kg·m−2, or 30 kg·m−2 with obesity-related co-morbidity to a 1-year programme. A cohort of 230 participants was recruited and evaluated using the National Obesity Observatory Standard Evaluation Framework. The primary outcome was weight loss of at least 5% of baseline weight at 12 months. Diet was assessed using the two-item food frequency questionnaire, activity using the General Practice Physical Activity questionnaire and quality of life using the EuroQol-5D-5L questionnaire. A focus group explored the participants' experiences. Baseline mean weight was 124.4 kg and mean body mass index was 44.1 kg·m−2. A total of 102 participants achieved 5% weight loss at 12 months. The mean weight loss was 10.2 kg among the 117 participants who completed the 12-month programme. Baseline observation carried forward analysis gave a mean weight loss of 5.9 kg at 12 months. Fruit and vegetable intake, activity level and quality of life all improved. The dropout rate was 14.3% at 6 months and 45.1% at 1 year. Focus group participants described high levels of satisfaction. It was possible to deliver a Tier 3 weight management service for obese patients with complex co-morbidity in a primary care setting with a full multidisciplinary team, which obtained good health outcomes compared with existing services

Determination of the chromospheric quiet network element area index and its variation during 2008-2011

Generally it has been considered that the plages and sunspots are the main contributors to the solar irradiance. There are small scale structures on the sun with intermediate magnetic fields that could also contribute to the solar irradiance. It has not yet been quantified how much of these small scale structures contribute to the solar irradiance and how much it varies over the solar cycle. In this paper, we used Ca II K images obtained from the telescope installed at Kodaikanal observatory. We report a method to separate the network elements from the background structure and plage regions. We compute the changes in the network element area index during the minimum phase of solar cycle and part of the ascending phase of cycle 24. The measured area occupied by the network elements is about 30% and plages less than 1% of the solar disk during the observation period from February 2008-2011. During the extended period of minimum activity it is observed that the network element area index decreases by about 7% compared to the area occupied by the network elements in 2008. A long term study of network element area index is required to understand the variations over the solar cycle.Comment: 12 pages, 9 Figures, Accepted for publication in RA

Lithological Discrimination of Anorthosite using ASTER data in Oddanchatram Area, Dindigul district, Tamil Nadu, India

The present study applies with hyperspectral remote sensing techniques to map the lithology of the Oddanchatram anorthosite. The hyperspectral data were subjected to Principal Component Analysis (PCA), Independent Component Analysis (ICA) and Minimum Noise Fraction (MNF), Pixel Purity Index (PPI) and n-Dimensional Visualization for better lithology mapping. The proposed study area has various typical rock types. The PCA, ICA and MNF have been proposed best band combination for effectiveness of lithological mapping such as PCA (R: G: B=2:1:3), MNF (R: G: B=4:3:2) and ICA (R: G: B=3:1:2). The derived lithological map has compared with published geological map from Geological Survey of India and validated with field investigation. Therefore, ASTER data based lithological mapping are fast, cost-effective and more accurate

Analysis and Measurement of Wave Guides Using Poisson Method

The Poisson equation is used to analyze and measure the waveguide in quick and exact calculation of Green's capacity. For this reason, Green's capacity is composed as far as Jacobian elliptic capacities including complex contentions. Another calculation for the quick and precise assessment of such Green's capacity is definite. The principle advantage of this calculation is effectively appeared inside the casing of the Limit Integral Resonant Mode Expansion technique, where a generous decrease of the computational exertion identified with the assessment of the referred to Green's capacity is gotten

6-Amino-3,4-dimethyl-4-phenyl-2H,4H-pyrano[2,3-c]pyrazole-5-carbonitrile

In the title compound, C15H14N4O, the pyrazole ring is aligned at 88.23 (4)° with respect to the aromatic ring and at 3.75 (4)° with respect to the pyran ring. In the crystal, N—H⋯N hydrogen bonds link adjacent mol­ecules into a linear chain motif. C—H⋯N inter­actions are also observed

Fuzzy Logic Harmony in Water: Mamdani Inference System Applied to Evaluate Pristine Pond Water Quality

Aquatic ecosystems that are subject to urbanization and environmental changes, such as the Kapaleeswarar and Chitrakulam tanks, depend on evaluating water quality. Their complicated data present challenges for conventional approaches. The usefulness of the Mamdani fuzzy inference system in determining the water quality in these tanks is investigated in this work. It creates a comprehensive assessment based on subject-matter expertise by handling ambiguous descriptors with linguistic variables and fuzzy sets. The system’s procedures for implementation are described in detail, with an emphasis on how well they can manage interrelated variables. The study shows how well the system measures the water quality in tanks and suggests ways to improve it. Tank evaluation that incorporates the Mamdani system encourages comprehensive resource management and cultural preservation

Application of the rainbow trout derived intestinal cell line (RTgutGC) for ecotoxicological studies: molecular and cellular responses following exposure to copper.

There is an acknowledged need for in vitro fish intestinal model to help understand dietary exposure to chemicals in the aquatic environment. The presence and use of such models is however largely restrictive due to technical difficulties in the culturing of enterocytes in general and the availability of appropriate established cell lines in particular. In this study, the rainbow trout (Oncorhynchus mykiss) intestinal derived cell line (RTgutGC) was used as a surrogate for the "gut sac" method. To facilitate comparison, RTgutGC cells were grown as monolayers (double-seeded) on permeable Transwell supports leading to a two-compartment intestinal model consisting of polarised epithelium. This two-compartment model divides the system into an upper apical (lumen) and a lower basolateral (portal blood) compartment. In our studies, these cells stained weakly for mucosubstances, expressed the tight junction protein ZO-1 in addition to E-cadherin and revealed the presence of polarised epithelium in addition to microvilli protrusions. The cells also revealed a comparable transepithelial electrical resistance (TEER) to the in vivo situation. Importantly, the cell line tolerated apical saline (1:1 ratio) thus mimicking the intact organ to allow assessment of uptake of compounds across the intestine. Following an exposure over 72 h, our study demonstrated that the RTgutGC cell line under sub-lethal concentrations of copper sulphate (Cu) and modified saline solutions demonstrated uptake of the metal with saturation levels comparable to short term ex situ gut sac preparations. Gene expression analysis revealed no significant influence of pH or time on mRNA expression levels of key stress related genes (i.e. CYP3A, GST, mtA, Pgp and SOD) in the Transwell model. However, significant positive correlations were found between all genes investigated suggesting a co-operative relationship amongst the genes studied. When the outlined characteristics of the cell line are combined with the division of compartments, the RTgutGC double seeded model represents a potential animal replacement model for ecotoxicological studies. Overall, this model could be used to study the effects and predict aquatic gastrointestinal permeability of metals and other environmentally relevant contaminants in a cost effective and high throughput manner

Clinical Outcomes of Rotator Cuff Repair With Subacromial Bursa Reimplantation: A Retrospective Cohort Study

BACKGROUND: The subacromial bursa has been found to be a rich, local, source of mesenchymal stem cells but is removed for visualization during rotator cuff repair. Reimplantation of this tissue may improve rotator cuff healing. The purpose of this study is to evaluate clinical outcomes of rotator cuff repair with and without subacromial bursa reimplantation. METHODS: Patients aged 37-77 with a full-thickness or near full-thickness supraspinatus tears underwent arthroscopic transosseous-equivalent double row rotator cuff repair. In patients prior to July 2019, the subacromial bursa was resected for visualization, and discarded. In patients after July 2019, the subacromial bursa was collected using a filtration device connected to an arthroscopic shaver and reapplied to the bursal surface of the tendon at the completion of the rotator cuff repair. Rotator cuff integrity was evaluated via magnetic resonance imaging on bursa patients at 6 months postoperatively. Minimum 18-month clinical outcomes (Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, patient satisfaction) were compared between bursa and nonbursa cohorts. RESULTS: A total of 136 patients were included in the study (control n = 110, bursa n = 26). Preoperative demographics and tear characteristics were not different between groups. Average follow-up was significantly longer in the control group (control: 3.2 ± 0.7 years; bursa: 1.8 ± 0.3 years; CONCLUSION: Augmentation of rotator cuff repair with bursal tissue does not appear to have negative effects, and given the accessibility and ease of harvest of this tissue, further research should be performed to evaluate its potential for improved tendon healing or clinical outcomes

CLUSTERING BASED ROUTING FOR DELAY- TOLERANT NETWORKS

ABSTRACT Delay-tolerant networking (DTN) is an approach to computer network Clustering significantly reduces the energy consumption of a cluster. In this paper, a cluster based routing protocol for Delay-Tolerant Mobile Networks (DTMNs) is used. Exponentially weighted moving average (EWMA) scheme is employed for on-line updating region contact probability, with its mean proven to converge to the true contact probability. The gateway nodes exchange network information and perform routing. It uses clustering's structure to decrease overhead, average end-to-end delay and improve the average packet delivery ratio