The use and effectiveness of behavioural modification techniques in achieving and maintaining normal weight and fitness – the lifestyle changes for adults in Cyprus

BACKGROUND and AIM: Research showed that behavioural modification techniques were the most effective way to achieve and maintain a healthy weight compared to diet and exercise alone. If behavioural modification was the most effective technique, then at least the two thirds of the candidates (Weight Loss Candidate with Behaviour Modification-WLCB) who used the specific behavioural modification techniques regarding eating and physical activity would achieve a weight loss of average ½ -1kg per week for the 18 weeks of the treatment and then maintain it or continue to lose after treatment termination with a total treatment period of 36 weeks. The treatment was efficient and long-lasting compared to the control candidates who followed a diet plan only. Furthermore, if the use of behavioural modification was the most effective way for diet and exercise, then the weight loss and maintenance would be more efficient and long-lasting. The principal aim of this project was to develop behaviour modification techniques (protocol and guidelines) in order to promote effective weight management for sedentary and active Cypriot adults, concentrating on nutrition and exercise. STUDY DESIGN: The study was quantitative and qualitative in nature using an action research approach. Furthermore, it was observational and longitudinal using structured methods and a representative sample of adults 19-50 years of age is investigated for 36 weeks. METHODS: Anthropometric data and health and diet history were taken using standard methods from 315 (the control and intervention group (1:1) Cypriot adults from rural and urban areas. Individualised diet plans, personalised physical activities as well as behavioural modification parameters were assessed with the aid of a questionnaire, interview, food and exercise diary and behavioural checklist. Obesity and overweight were defined using the current International Obesity Task Force definition. The validated questionnaires for Physical Activity (IPAQ) and the nutritional assessment (National Integrated Health Associates) were used for initial assessment and the behavioural checklists were used for the follow up. Behavioural checklists were completed by the candidates on a bi-weekly basis along with the food and exercise diary. The questionnaire reliability (test-retest), internal consistency and ability to differentiate obese vs. normal-weight adult behaviours were tested using a pilot population of 50 adults not enrolled in a formal weight loss programme. Its reliability (checklists, food and exercise diary) and predictive validity were tested using a selective population: 265 adults of the observational group enrolled in behavioural modification treatment vs. diet. OBJECTIVES OF THE STUDY: Τhe objectives of the research were a) The study of every aspect of weight management and thus be capable of making suggestions for the development of guidelines and protocols for behavioural modification to health professionals working with the public. b) The identification and adjustment of eating and exercise behaviour related to body weight in order to achieve an efficient weight management in Cypriot overweight/obese adults. c) The evaluation of the effectiveness of the modest lifestyle changes in weight management induced by short-term energy/calorie restriction and behaviour modification in overweight and obese Greek Cypriots with Body Mass Index (BMI) above 25 or 30 respectively, or body weight 20% or above of Ideal Body weight (IBW), or body fat above normal levels. d) The development of education and counselling protocols and guidelines for professionals for weight management protocols based on the Mediterranean Diet and the eating and exercise habits of Cypriot Adults. e) The implementation of the protocols to intervention groups in order to identify the efficiency. OUTCOMES: The outcomes of the project was the development of an education and counselling protocol/manual which included teaching tools and guidelines for professionals for weight management with the title “Protocol and Guidelines for professional users for weight management for Adults: assessment, categorization, therapy/ follow up of overweight and obesity”. The development of an eating behaviour and physical activity protocol/manual based on the Mediterranean Diet and the demonstrated eating and exercise habits of Cypriot Adults can be used by the stakeholders and the public for efficient and effective weight management. RESULTS: The average length of weight loss treatment was 18 weeks for the intervention and the control groups, and the average weight loss for the intervention group was 11.96kg (t-test, p-value ≤ 0.001) and for the control group was 5.56kg (t-test, p-value≤ 0.002). During the 18 weeks of the maintenance period the 50% of the intervention group continued to lose while, an additional 48% of them maintained the weight and only 2% of them gained weight. CONCLUSIONS: To conclude, the prevalence of obesity worldwide has reached epidemic proportions. Physical inactivity and poor diet have been identified as primary contributors to the leading causes of death in developed countries including Cyprus. It is unfortunate that more emphasis is given to calorie restriction dieting rather than behavioural modification for diet and physical activity in achieving and maintaining weight loss. The fact is that incorporating appropriate behavioural modification techniques for diet and sufficient physical activity into one’s life is an essential component of achieving a healthy body weight. The research project aimed at developing a behavioural approach and behavioural modification techniques for the treatment of obesity and weight management adjusted to the needs of the Cypriot adult population. The difference of this approach underlines the emphasis that has to be given to the follow-up programme for the maintenance of the weight loss through behavioural modification. This approach evolved from the environmental control of eating behaviour to a broader approach characterized by systematic manipulation of all factors associated with eating and exercise patterns. The need for the project derives from the fact that obesity is a chronic condition with a substantial potential for relapse; therefore long–term treatments are needed. The expected outcomes of this project are the development of guidelines and protocols to be used by health professionals. The ultimate goal is the reduction of the obesity epidemic in Cyprus

Generalized Heisenberg algebras and k-generalized Fibonacci numbers

It is shown how some of the recent results of de Souza et al. [1] can be generalized to describe Hamiltonians whose eigenvalues are given as k-generalized Fibonacci numbers. Here k is an arbitrary integer and the cases considered by de Souza et al. corespond to k=2.Comment: 8 page

A high throughput zebrafish chemical screen reveals ALK5 and non-canonical androgen signalling as modulators of the pkd2−/− phenotype

Autosomal dominant polycystic kidney disease (ADPKD) is the most common monogenic cause of end-stage renal failure in humans and results from germline mutations in PKD1 or PKD2. Despite the recent approval of tolvaptan, safer and more effective alternative drugs are clearly needed to slow disease progression. As a first step in drug discovery, we conducted an unbiased chemical screen on zebrafish pkd2 mutant embryos using two publicly available compound libraries (Spectrum, PKIS) totalling 2,367 compounds to identify novel treatments for ADPKD. Using dorsal tail curvature as the assay readout, three major chemical classes (steroids, coumarins, flavonoids) were identified from the Spectrum library as the most promising candidates to be tested on human PKD1 cystic cells. Amongst these were an androgen, 5α−androstane 3,17-dione, detected as the strongest enhancer of the pkd2 phenotype but whose effect was found to be independent of the canonical androgen receptor pathway. From the PKIS library, we identified several ALK5 kinase inhibitors as strong suppressors of the pkd2 tail phenotype and in vitro cyst expansion. In summary, our results identify ALK5 and non-canonical androgen receptors as potential therapeutic targets for further evaluation in drug development for ADPKD

Interventions to promote patients and families' involvement in adult intensive care settings: a protocol for a mixed-method systematic review.

BACKGROUND: There has been an identified need for greater patient and family member involvement in healthcare. This is particularly relevant in an intensive care unit (ICU), as the family provides a key communicative and practical link between patient and clinician. Family members have been deemed a positive beneficial influence on ICU care and recovery processes, yet they themselves are often emotionally affected after discharge. There has been no standardised evidenced-based approach which explores research on family member involvement and the range and quality of contributions remain unclear. This project will undertake a systematic review to assess the evidence base for interventions designed to promote patient and family member involvement in adult intensive care settings and develop a comprehensive typology of interventions for use by clinicians, patients and carers. METHODS: The following databases will be searched without date restriction: MEDLINE, EMBASE and CINAHL, as well as the Cochrane Central Register of Controlled Trials, Joanna Briggs and Cochrane Libraries. Manual searches of recent back issues of leading ICU and patient experience journals will also be undertaken, as will the reference lists of included studies. Unpublished literature will be sought through grey literature databases, including GreyLit and OpenGrey. All evaluation studies that consider intervention activities to promote patient and family member involvement in adult ICUs will be included; all research designs will be eligible. We will seek to include studies that report on a mixture of relevant outcomes for patients and family members. Abstracts and papers will be independently screened by at least two members of the team to determine their inclusion. Included papers will be assessed for methodological rigour using a standard rating approach, which assesses 'quality of study' and 'quality of information'. Quality assessment will be completed by at least two members of the team. Data on interventions, evaluation methods and outcomes will be collated using a predetermined extraction table. These are likely to be heterogeneous in nature, which will mean that the review will follow a narrative approach to synthesis. DISCUSSION: The review will provide valuable and rigorous insight into the range and quality of interventions available to promote patient and family member involvement in ICU. This is the first step towards addressing the absence of a synthesis of research for this context, and will, in addition, develop a typology of available interventions that will help service users and clinicians make informed decisions about the approaches to patient and family member involvement which they might want to adopt. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42018086325)

"`They brought in the horrible key ring thing!" Analysing the Usability of Two-Factor Authentication in UK Online Banking

To prevent password breaches and guessing attacks, banks increasingly turn to two-factor authentication (2FA), requiring users to present at least one more factor, such as a one-time password generated by a hardware token or received via SMS, besides a password. We can expect some solutions -- especially those adding a token -- to create extra work for users, but little research has investigated usability, user acceptance, and perceived security of deployed 2FA. This paper presents an in-depth study of 2FA usability with 21 UK online banking customers, 16 of whom had accounts with more than one bank. We collected a rich set of qualitative and quantitative data through two rounds of semi-structured interviews, and an authentication diary over an average of 11 days. Our participants reported a wide range of usability issues, especially with the use of hardware tokens, showing that the mental and physical workload involved shapes how they use online banking. Key targets for improvements are (i) the reduction in the number of authentication steps, and (ii) removing features that do not add any security but negatively affect the user experience

Dietary glycaemic index and cognitive function: prospective associations in adults of the 1946 British birth cohort

OBJECTIVE: Evidence suggests that the rate of glucose release following consumption of carbohydrate-containing foods, defined as the glycaemic index (GI), is inversely associated with cognitive function. To date, most of the evidence stems from either single-meal studies or highly heterogeneous cohort studies. We aimed to study the prospective associations of diet GI at age 53 years with outcomes of verbal memory and letter search tests at age 69 years and rate of decline between 53 and 69 years. DESING: Longitudinal population-based birth cohort study. SETTING: MRC National Survey for Health and Development. PARTICIPANTS: Cohort members (n 1252). RESULTS: Using multivariable linear and logistic regression, adjusted for potential confounders, associations of higher-GI diet with lower verbal memory, lower letter search speed and lower number of hits in a letter search test were attenuated after adjustments for cognitive ability at age 15 years, educational attainment, further training and occupational social class. No association was observed between diet GI at 53 years and letter search accuracy or speed–accuracy trade-off at 69 years, or between diet GI at 53 years and rate of decline between 53 and 69 years in any cognitive measure. CONCLUSIONS: Diet GI does not appear to predict cognitive function or decline, which was mainly explained by childhood cognitive ability, education and occupational social class. Our findings confirm the need for further research on the association between diet and cognition from a life-course perspective

Fibrin clot structure remains unaffected in young, healthy individuals after transient exposure to diesel exhaust

Exposure to urban particulate matter has been associated with an increased risk of cardiovascular disease and thrombosis. We studied the effects of transient exposure to diesel particles on fibrin clot structure of 16 healthy individuals (age 21- 44). The subjects were randomly exposed to diesel exhaust and filtered air on two separate occasions. Blood samples were collected before exposure, and 2 and 6 hours after exposure. There were no significant changes on clot permeability, maximum turbidity, lag time, fibre diameter, fibre density and fibrinogen level between samples taken after diesel exhaust exposure and samples taken after filtered air exposure. These data show that there are no prothrombotic changes in fibrin clot structure in young, healthy individuals exposed to diesel exhaust

Breakfast glycaemic index and exercise: combined effects on adolescents' cognition

The aim of the present study was to examine the combined effects of breakfast glycaemic index (GI) and a mid-morning bout of exercise on adolescents’ cognitive function. Participants were randomly allocated to a high or low GI breakfast group in a mixed research design, where each participant completed two experimental trials (exercise and resting). Forty-two adolescents (12.4±0.5 years old), undertook a bout of exercise (ten repeats of level one of the multi-stage fitness test; exercise trial) or continued to rest (resting trial) following consumption of either a high or low GI breakfast. A battery of cognitive function tests (visual search test, Stroop test and Sternberg paradigm) was completed 30 min before and 45 min following the exercise. Average heart rate during exercise was 170±15 beats.min-1. On the complex level of the Stroop test, response times improved across the morning following the low GI breakfast on both the exercise and resting trials, though the improvement was greatest on the exercise trial. However, response times only improved on the resting trial following the high GI breakfast (p = 0.012). On the 5 letter level of the Sternberg paradigm, response times improved across the morning following the low GI breakfast (regardless of exercise) and only on the exercise trial following the high GI breakfast (p = 0.019). The findings of the present study suggest that the combined effects of breakfast GI and exercise in adolescents depend upon the component of cognitive function examined. A low GI breakfast and mid-morning bout of exercise were individually beneficial for response times on the Sternberg paradigm, whereas they conferred additional benefits for response times on the Stroop test

Submesothelial deposition of carbon nanoparticles after toner exposition: Case report

Inhalation of carbon nanoparticles (CNP) from toner dust has been shown to have impact on the respiratory health of persons exposed. Office printers are known emitters of CNP. We report about a female open office worker who developed weight loss and diarrhoea. Laparoscopy done for suspected endometriosis surprisingly revealed black spots within the peritoneum. Submesothelial aggregates of CNP with a diameter of 31-67 nm were found by scanning and transmission electron microscopy in these tissue specimens. Colon biopsies showed inflammatory bowel disease with typically signs of Crohn disease, but no dust deposits. Transport of CNP via lymphatic and blood vessels after inhalation in the lungs has to be assumed. In this case respiratory symptoms were not reported, therefore no lung function tests were done. We have shown that workers with toner dust exposure from laser printers can develop submesothelial deposition of CNP in the peritoneum. Impact of toner dust exposure on the respiratory health of office workers, as suspected in other studies, has to be evaluated further