Primary care providers\u27 perspectives on online weight-loss programs: a big wish list

BACKGROUND: Integrating online weight-loss programs into the primary care setting could yield substantial public health benefit. Little is known about primary care providers\u27 perspectives on online weight-loss programs. OBJECTIVE: To assess primary care providers\u27 perspectives on online weight-loss programs. METHODS: We conducted focus group discussions with providers in family medicine, internal medicine, and combined internal medicine/pediatrics in Texas and Pennsylvania, USA. Open-ended questions addressed their experience with and attitudes toward online weight-loss programs; useful characteristics of existing online weight-loss programs; barriers to referring patients to online weight-loss programs; and preferred characteristics of an ideal online weight-loss program. Transcripts were analyzed with the grounded theory approach to identify major themes. RESULTS: A total of 44 primary care providers participated in 9 focus groups. The mean age was 45 (SD 9) years. Providers had limited experience with structured online weight-loss programs and were uncertain about their safety and efficacy. They thought motivated, younger patients would be more likely than others to respond to an online weight-loss program. According to primary care providers, an ideal online weight-loss program would provide-at no cost to the patient-a structured curriculum addressing motivation, psychological issues, and problem solving; tools for tracking diet, exercise, and weight loss; and peer support monitored by experts. Primary care providers were interested in receiving reports about patients from the online weight-loss programs, but were concerned about the time required to review and act on the reports. CONCLUSIONS: Primary care providers have high expectations for how online weight-loss programs should deliver services to patients and fit into the clinical workflow. Efforts to integrate online weight-loss programs into the primary care setting should address efficacy and safety of online weight-loss programs in clinic-based populations; acceptable methods of sending reports to primary care providers about their patients\u27 progress; and elimination or reduction of costs to patients

Sea Level Rise Explains Changing Carbon Accumulation Rates in a Salt Marsh Over the Past Two Millennia

High rates of carbon burial observed in wetland sediments have garnered attention as a potential “natural fix” to reduce the concentration of carbon dioxide (CO2) in Earth's atmosphere. A carbon accumulation rate (CAR) can be determined through various methods that integrate a carbon stock over different time periods, ranging from decades to millennia. Our goal was to assess how CAR changed over the lifespan of a salt marsh. We applied a geochronology to a series of salt marsh cores using both 14C and 210Pb markers to calculate CARs that were integrated between 35 and 2,460 years before present. CAR was 39 g C·m−2·year−1 when integrated over millennia but was upward of 148 g C·m−2·year−1 for the past century. We present additional evidence to account for this variability by linking it to changes in relative sea level rise (RSLR), where higher rates of RSLR were associated with higher CARs. Thus, the CAR calculated for a wetland should integrate timescales that capture the influence of contemporary RSLR. Therefore, caution should be exercised not to utilize a CAR calculated over inappropriately short or long timescales as a current assessment or forecasting tool for the climate change mitigation potential of a wetland

The Glial Regenerative Response to Central Nervous System Injury Is Enabled by Pros-Notch and Pros-NFκB Feedback

Organisms are structurally robust, as cells accommodate changes preserving structural integrity and function. The molecular mechanisms underlying structural robustness and plasticity are poorly understood, but can be investigated by probing how cells respond to injury. Injury to the CNS induces proliferation of enwrapping glia, leading to axonal re-enwrapment and partial functional recovery. This glial regenerative response is found across species, and may reflect a common underlying genetic mechanism. Here, we show that injury to the Drosophila larval CNS induces glial proliferation, and we uncover a gene network controlling this response. It consists of the mutual maintenance between the cell cycle inhibitor Prospero (Pros) and the cell cycle activators Notch and NFκB. Together they maintain glia in the brink of dividing, they enable glial proliferation following injury, and subsequently they exert negative feedback on cell division restoring cell cycle arrest. Pros also promotes glial differentiation, resolving vacuolization, enabling debris clearance and axonal enwrapment. Disruption of this gene network prevents repair and induces tumourigenesis. Using wound area measurements across genotypes and time-lapse recordings we show that when glial proliferation and glial differentiation are abolished, both the size of the glial wound and neuropile vacuolization increase. When glial proliferation and differentiation are enabled, glial wound size decreases and injury-induced apoptosis and vacuolization are prevented. The uncovered gene network promotes regeneration of the glial lesion and neuropile repair. In the unharmed animal, it is most likely a homeostatic mechanism for structural robustness. This gene network may be of relevance to mammalian glia to promote repair upon CNS injury or disease

NG2 and phosphacan are present in the astroglial scar after human traumatic spinal cord injury

BACKGROUND: A major class of axon growth-repulsive molecules associated with CNS scar tissue is the family of chondroitin sulphate proteoglycans (CSPGs). Experimental spinal cord injury (SCI) has demonstrated rapid re-expression of CSPGs at and around the lesion site. The pharmacological digestion of CSPGs in such lesion models results in substantially enhanced axonal regeneration and a significant functional recovery. The potential therapeutic relevance of interfering with CSPG expression or function following experimental injuries seems clear, however, the spatio-temporal pattern of expression of individual members of the CSPG family following human spinal cord injury is only poorly defined. In the present correlative investigation, the expression pattern of CSPG family members NG2, neurocan, versican and phosphacan was studied in the human spinal cord. METHODS: An immunohistochemical investigation in post mortem samples of control and lesioned human spinal cords was performed. All patients with traumatic SCI had been clinically diagnosed as having "complete" injuries and presented lesions of the maceration type. RESULTS: In sections from control spinal cord, NG2 immunoreactivity was restricted to stellate-shaped cells corresponding to oligodendrocyte precursor cells. The distribution patterns of phosphacan, neurocan and versican in control human spinal cord parenchyma were similar, with a fine reticular pattern being observed in white matter (but also located in gray matter for phosphacan). Neurocan staining was also associated with blood vessel walls. Furthermore, phosphacan, neurocan and versican were present in the myelin sheaths of ventral and dorsal nerve roots axons. After human SCI, NG2 and phosphacan were both detected in the evolving astroglial scar. Neurocan and versican were detected exclusively in the lesion epicentre, being associated with infiltrating Schwann cells in the myelin sheaths of invading peripheral nerve fibres from lesioned dorsal roots. CONCLUSION: NG2 and phosphacan were both present in the evolving astroglial scar and, therefore, might play an important role in the blockade of successful CNS regeneration. Neurocan and versican, however, were located at the lesion epicentre, associated with Schwann cell myelin on regenerating peripheral nerve fibres, a distribution that was unlikely to contribute to failed CNS axon regeneration. The present data points to the importance of such correlative investigations for demonstrating the clinical relevance of experimental data

Unconscious bias and the medical model: How the social model may hold the key to transformative thinking about disability discrimination

This article seeks to gain access to a new way to engage with disability discrimination and the legal approaches to it by focusing on the two central models: the medical and social models. It discusses how the law has based the definition of disability on the medical model and suggests that this may strengthen some of the underlying factors that contribute to segregation and discrimination of disabled people. This article argues that the law should now switch focus to the social model, in an attempt to transform people’s attitudes towards disabled people and become a positive force to reduce discrimination. It makes reference to the reasonable adjustment duty contained in sections 20 and 21 Equality Act 2010, the Framework Directive and by way of comparison the American with Disabilities Act 1990. Relevant critical theories are integrated as a means to explore the conception and the hierarchy that exist between able-bodied individuals and disabled individuals

Progress and prospects of thermo-mechanical energy storage—a critical review

Abstract: The share of electricity generated by intermittent renewable energy sources is increasing (now at 26% of global electricity generation) and the requirements of affordable, reliable and secure energy supply designate grid-scale storage as an imperative component of most energy transition pathways. The most widely deployed bulk energy storage solution is pumped-hydro energy storage (PHES), however, this technology is geographically constrained. Alternatively, flow batteries are location independent and have higher energy densities than PHES, but remain associated with high costs and short lifetimes, which highlights the importance of developing and utilizing additional larger-scale, longer-duration and long-lifetime energy storage alternatives. In this paper, we review a class of promising bulk energy storage technologies based on thermo-mechanical principles, which includes: compressed-air energy storage, liquid-air energy storage and pumped-thermal electricity storage. The thermodynamic principles upon which these thermo-mechanical energy storage (TMES) technologies are based are discussed and a synopsis of recent progress in their development is presented, assessing their ability to provide reliable and cost-effective solutions. The current performance and future prospects of TMES systems are examined within a unified framework and a thermo-economic analysis is conducted to explore their competitiveness relative to each other as well as when compared to PHES and battery systems. This includes carefully selected thermodynamic and economic methodologies for estimating the component costs of each configuration in order to provide a detailed and fair comparison at various system sizes. The analysis reveals that the technical and economic characteristics of TMES systems are such that, especially at higher discharge power ratings and longer discharge durations, they can offer promising performance (round-trip efficiencies higher than 60%) along with long lifetimes (>30 years), low specific costs (often below 100 $ kWh−1), low ecological footprints and unique sector-coupling features compared to other storage options. TMES systems have significant potential for further progress and the thermo-economic comparisons in this paper can be used as a benchmark for their future evolution

Progress and prospects of thermo-mechanical energy storage—a critical review

Abstract: The share of electricity generated by intermittent renewable energy sources is increasing (now at 26% of global electricity generation) and the requirements of affordable, reliable and secure energy supply designate grid-scale storage as an imperative component of most energy transition pathways. The most widely deployed bulk energy storage solution is pumped-hydro energy storage (PHES), however, this technology is geographically constrained. Alternatively, flow batteries are location independent and have higher energy densities than PHES, but remain associated with high costs and short lifetimes, which highlights the importance of developing and utilizing additional larger-scale, longer-duration and long-lifetime energy storage alternatives. In this paper, we review a class of promising bulk energy storage technologies based on thermo-mechanical principles, which includes: compressed-air energy storage, liquid-air energy storage and pumped-thermal electricity storage. The thermodynamic principles upon which these thermo-mechanical energy storage (TMES) technologies are based are discussed and a synopsis of recent progress in their development is presented, assessing their ability to provide reliable and cost-effective solutions. The current performance and future prospects of TMES systems are examined within a unified framework and a thermo-economic analysis is conducted to explore their competitiveness relative to each other as well as when compared to PHES and battery systems. This includes carefully selected thermodynamic and economic methodologies for estimating the component costs of each configuration in order to provide a detailed and fair comparison at various system sizes. The analysis reveals that the technical and economic characteristics of TMES systems are such that, especially at higher discharge power ratings and longer discharge durations, they can offer promising performance (round-trip efficiencies higher than 60%) along with long lifetimes (>30 years), low specific costs (often below 100 $ kWh−1), low ecological footprints and unique sector-coupling features compared to other storage options. TMES systems have significant potential for further progress and the thermo-economic comparisons in this paper can be used as a benchmark for their future evolution