Aspiration therapy for the treatment of obesity: 4-year results of a multicenter randomized controlled trial.

BackgroundThe AspireAssist is the first Food and Drug Administration-approved endoluminal device indicated for treatment of class II and III obesity.ObjectivesWe earlier reported 1-year results of the PATHWAY study. Here, we report 4-year outcomes.SettingUnited States-based, 10-center, randomized controlled trial involving 171 participants with the treatment arm receiving Aspiration Therapy (AT) plus Lifestyle Therapy and the control arm receiving Lifestyle Therapy (2:1 randomization).MethodsAT participants were permitted to continue in the study for an additional year up to a maximum of 5 years providing they maintained at least 10% total weight loss (TWL) from baseline at each year end. For AT participants who continued the study, 5 medical monitoring visits were provided at weeks 60, 68, 76, 90, and 104 and thereafter once every 13 weeks up to week 260. Exclusion criteria were a history of eating disorder or evidence of eating disorder on a validated questionnaire. Follow-up weight, quality of life, and co-morbidities were compared with the baseline levels. In addition, rates of serious adverse event, persistent fistula, withdrawal, and A-tube replacement were reported. All analyses were performed using a per-protocol analysis.ResultsOf the 82 AT participants who completed 1 year, 58 continued to this phase of the trial. Mean baseline body mass index of these 58 patients was 41.6 ± 4.5 kg/m2. At the end of first year (at the beginning of the follow-up study), these 58 patients had a body mass index of 34.1 ± 5.4 kg/m2 and had achieved an 18.3 ± 8.0% TWL. On a per protocol basis, patients experienced 14.2%, 15.3%, 16.6%, and 18.7% TWL at 1, 2, 3, and 4 years, respectively (P < .01 for all). Forty of 58 patients (69%) achieved at least 10% TWL at 4 years or at time of study withdrawal. Improvements in quality of life scores and select cardiometabolic parameters were also maintained through 4 years. There were 2 serious adverse events reported in the second through fourth years, both of which resolved with removal or replacement of the A tube. Two persistent fistulas required surgical repair, representing approximately 2% of all tube removals. There were no clinically significant metabolic or electrolytes disorders observed, nor any evidence for development of any eating disorders.ConclusionsThe results of this midterm study have shown that AT is a safe, effective, and durable weight loss alternative for people with class II and III obesity and who are willing to commit to using the therapy and adhere to adjustments in eating behavior

Participatory action research in two communities in Bolivia and the United States

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66665/2/10.1177_002087289203500214.pd

Using accelerometers to determine the calling behavior of tagged baleen whales

Low-frequency acoustic signals generated by baleen whales can propagate over vast distances, making the assignment of calls to specific individuals problematic. Here, we report the novel use of acoustic recording tags equipped with high-resolution accelerometers to detect vibrations from the surface of two tagged fin whales that directly match the timing of recorded acoustic signals. A tag deployed on a buoy in the vicinity of calling fin whales and a recording from a tag that had just fallen off a whale were able to detect calls acoustically but did not record corresponding accelerometer signals that were measured on calling individuals. Across the hundreds of calls measured on two tagged fin whales, the accelerometer response was generally anisotropic across all three axes, appeared to depend on tag placement and increased with the level of received sound. These data demonstrate that high-sample rate accelerometry can provide important insights into the acoustic behavior of baleen whales that communicate at low frequencies. This method helps identify vocalizing whales, which in turn enables the quantification of call rates, a fundamental component of models used to estimate baleen whale abundance and distribution from passive acoustic monitoring.Keywords: Whale, Acceleration, Acoustic

Indigenous identity, natural resources, and contentious politics in Bolivia: a disaggregated conflict analysis; 2000-2011

How do natural resources and ethnic identity interact to incite or to mitigate social conflict? This article argues that high-value natural resources can act as an important catalyst for the politicization of ethnic, specifically indigenous identity, and contribute to social conflict as they limit the malleability of identity frames and raise the stakes of confrontations. We test this argument using unique subnational data from Bolivian provinces. Drawing on Bolivian newspaper reports, we code conflict events for all of the 112 provinces from 2000 to 2011. We join this conflict data with information on local ethnic composition from the census, the political representation of ethnic groups at the national level, as well as geo-spatial information on gas deposits. Using time-series cross-sectional count models, we show a significant conflict-promoting effect of the share of indigenous people in provinces with gas reserves, but not without

Length of Stay After Childbirth in 92 Countries and Associated Factors in 30 Low- and Middle-Income Countries: Compilation of Reported Data and a Cross-sectional Analysis from Nationally Representative Surveys

Background: Following childbirth, women need to stay sufficiently long in health facilities to receive adequate care. Little is known about length of stay following childbirth in low- and middle-income countries or its determinants. Methods and Findings: We described length of stay after facility delivery in 92 countries. We then created a conceptual framework of the main drivers of length of stay, and explored factors associated with length of stay in 30 countries using multivariable linear regression. Finally, we used multivariable logistic regression to examine the factors associated with stays that were “too short” (<24 h for vaginal deliveries and <72 h for cesarean-section deliveries). Across countries, the mean length of stay ranged from 1.3 to 6.6 d: 0.5 to 6.2 d for singleton vaginal deliveries and 2.5 to 9.3 d for cesarean-section deliveries. The percentage of women staying too short ranged from 0.2% to 83% for vaginal deliveries and from 1% to 75% for cesarean-section deliveries. Our conceptual framework identified three broad categories of factors that influenced length of stay: need-related determinants that required an indicated extension of stay, and health-system and woman/family dimensions that were drivers of inappropriately short or long stays. The factors identified as independently important in our regression analyses included cesarean-section delivery, birthweight, multiple birth, and infant survival status. Older women and women whose infants were delivered by doctors had extended lengths of stay, as did poorer women. Reliance on factors captured in secondary data that were self-reported by women up to 5 y after a live birth was the main limitation. Conclusions: Length of stay after childbirth is very variable between countries. Substantial proportions of women stay too short to receive adequate postnatal care. We need to ensure that facilities have skilled birth attendants and effective elements of care, but also that women stay long enough to benefit from these. The challenge is to commit to achieving adequate lengths of stay in low- and middle-income countries, while ensuring any additional time is used to provide high-quality and respectful care

A review on applications of Cu2ZnSnS4 as alternative counter electrodes in dye-sensitized solar cells

A contribution of counter electrode (CE) emphasis a great impact towards enhancement of a dye-sensitized solar cell's (DSSC) performance and Pt based CE sets a significant benchmark in this field. Owing to cost effective noble metal, less abundance and industrial large scale application purpose, an effective replacement for Pt is highly demanded. There are several approaches to improve the performance of a CE for enhancing the power conversion efficiency with a less costly and facile device. To address this issue, reasonable efforts execute to find out suitable replacement of Pt is becoming a challenge by keeping the same electrochemical properties of Pt in a cheaper and eco-friendlier manner. With this, cheaper element based quaternary chalcogenide, Cu2ZnSnS4 (CZTS) becomes a prominent alternative to Pt and used as a successful CE in DSSC also. This review presents brief discussion about the basic properties of CZTS including its synthesis strategy, physicochemical properties and morphology execution and ultimate application as an alternative Pt free CE for a low cost based enhanced DSSC device. It is therefore, imperative for engineering of CZTS material and optimization of the fabrication method for the improvement of DSSC performance