Summary
Recent research has provided evidence that bariatric surgery maximizes long‐term weight loss in patients with severe obesity. However, a substantial number of patients experience poor weight ...loss outcome and weight regain over time. Post‐operative behavioural management may facilitate long‐term weight control in bariatric surgery population. The objective of this systematic review and meta‐analysis was to determine the effects of post‐operative behavioural management on weight loss following bariatric surgery. Eligible articles were systematically searched in electronic databases. Among the 414 citations, five randomized controlled trials, two prospective and eight retrospective cohort trials analysing behavioural lifestyle interventions and support groups fulfilled the inclusion criteria. The main finding is that behavioural management had a positive effect on weight loss following surgery. In 13 studies, patients receiving behavioural management had greater weight loss than patients receiving usual care or no treatment. A meta‐analysis of five randomized controlled trials suggests greater weight loss in patients with behavioural lifestyle interventions compared with control groups. Post‐operative behavioural management has the potential to facilitate optimal weight loss following bariatric surgery, but conclusions were limited by the small and heterogeneous samples of studies. A more rigorous empirical evaluation on its clinical significance is warranted to improve effectiveness of bariatric surgery.
Fluorophores are quantum objects that blink intermittently and whose dark states exist practically 'forever'--on quantum-mechanical scales, that is. Although there is no accepted theory, there has ...been plenty of theoretical progress.
The experimental sum frequency generation (SFG) spectrum is the response to an infrared pulse and a visible pulse and is a highly surface-sensitive technique. We treat the surface dangling OH bonds ...at the air/water interface and focus on the absolute SFG intensities for the resonant terms, a focus that permits insight into the consequences of some approximations. For the polarization combinations, the calculated linewidths for the water interface dangling OH SFG band at 3,700 cm-1 are, as usual, too large, because of the customary neglect of motional narrowing. The integrated spectrum is used to circumvent this problem and justified here using a Kubo-like formalism and theoretical integrated band intensities rather than peak intensities. Only relative SFG intensities are usually reported. The absolute integrated SFG intensities for three polarization combinations for sum frequency, visible, and infrared beams are computed. We use molecular dynamics and the dipole and the polarizability matrix elements obtained from infrared and Raman studies of H₂O vapor. The theoretical expressions for two of the absolute susceptibilities contain only a single term and agree with experiment to about a factor of 1.3, with no adjustable parameters. The Fresnel factors are included in that comparison. One of the susceptibilities contains instead four positive and negative terms and agrees less well. The expression for the SFG correlation function is normally derived from a statistical mechanical formulation using a time-evolving density matrix. We show how a derivation based on a two-field relaxation leads to the same final result.
Patients with heart failure with preserved ejection fraction (HFpEF) universally complain of exercise intolerance and dyspnoea as key clinical correlates. Cardiac as well as extracardiac components ...play a role for the limited exercise capacity, including an impaired cardiac and peripheral vascular reserve, a limitation in mechanical ventilation and/or gas exchange with reduced pulmonary vascular reserve, skeletal muscle dysfunction and iron deficiency/anaemia. Although most of these components can be differentiated and quantified through gas exchange analysis by cardiopulmonary exercise testing (CPET), the information provided by objective measures of exercise performance has not been systematically considered in the recent algorithms/scores for HFpEF diagnosis, by neither European nor US groups. The current clinical consensus statement by the Heart Failure Association (HFA) and European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC) aims at outlining the role of exercise testing and its pathophysiological, clinical and prognostic insights, addressing the implications of a thorough functional evaluation from the diagnostic algorithm to the pathophysiology and treatment perspectives of HFpEF. Along with these goals, we provide a specific analysis of the evidence that CPET is the standard for assessing, quantifying, and differentiating the origin of dyspnoea and exercise impairment and even more so when combined with echocardiography and/or invasive haemodynamic evaluation. This will lead to improved quality of diagnosis when applying the proposed scores and may also help to implement the progressive characterization of the specific HFpEF phenotypes, a critical step toward the delivery of phenotype‐specific treatments.
Prioritizing cardiopulmonary exercise testing (CPET) within the HFA‐PEFF diagnostic algorithm. Modified HFA‐PEFF diagnostic algorithm including CPET in Step 1 (P) pre‐assessment, and Step 4 (F) final aetiology. See text for details. Abbreviations: aBGA, arterial blood gas analysis; BP, blood pressure; BR, breathing reserve, ratio of VE/maximum volunatry ventilation; C(a–v)O2, difference in O2 content in arterial and mixed venous blood; CO, cardiac output; CV, cardiovascular; EELV, end‐expiratory lung volume; HR, heart rate; HRR, heart rate recovery; IC, inspiratory capacity; LV, left ventricular; MCR, metabolic‐chronotropic relationship; OUES, oxygen uptake efficiency slope; PA‐aO2, alveolar‐arterial oxygen gradient; PAP, pulmonary artery pressure; PCWP, pulmonary capillary wedge pressure; PVR, pulmonary vascular resistance; RAP, right atrial pressure; RER, respiratory exchange ratio; SaO2, arterial oxygen saturation; VCO2, carbon dioxide output; VD/VT, ratio of dead‐space ventilation to tidal ventilation; VE, ventilation; VFL/VT, percent of the tidal breath that expiratory air flow exceeds the maximal flow/volume envelope; VO2, oxygen consumption; VT, ventilatory threshold.
Earlier sum frequency generation (SFG) experiments involve one infrared and one visible laser, and a measurement of the intensity of the response, yielding data on the surface sensitive properties of ...the sample. Recently, both the real and imaginary components of the susceptibility were measured in two different sets of experiments. In one set, a broadband infrared laser was used, permitting observations at very short times, while in another set the infrared laser was narrowband, permitting higher spectral resolution. The differences in the spectrum obtained by the two will be most evident in studying narrow absorption bands, e.g., the band due to dangling OH bonds at a water interface. The direct comparisons in the integrated amplitude (sum rule) of the imaginary part of the dangling OH bond region differ by a factor of 3. Due to variations in experimental setup and data processing, corrections were made for the quartz reference, Fresnel factors, and the incident visible laser wavelength. After the corrections, the agreement differs now by the factors of 1.1 within broadband and narrowband groups and the two groups now differ by a factor of 1.5. The 1.5 factor may arise from the extra heating of the more powerful broadband laser system on the water surface. The convolution from the narrowband SFG spectrum to the broadband SFG spectrum is also investigated and it does not affect the sum rule. Theory and narrowband experiments are compared using the sum rule and agree to a factor of 1.3 with no adjustable parameters.
The United States offers near-universal coverage for treatment of ESRD. Undocumented immigrants with ESRD are the only subset of patients not covered under a national strategy. There are 2 divergent ...dialysis treatment strategies offered to undocumented immigrants in the United States, emergent dialysis and chronic outpatient dialysis. Emergent dialysis, offering dialysis only when urgent indications exist, is the treatment strategy in certain states. Differing interpretations of Emergency Medicaid statute by the courts and state and federal government have resulted in the geographic disparity in treatment strategies for undocumented immigrants with ESRD. The Patient Protection and Affordable Care Act of 2010 ignored the health care of undocumented immigrants and will not provide relief to undocumented patients with catastrophic illness like ESRD, cancer, or traumatic brain injuries. The difficult patient and provider decisions are explored in this review. The Renal Physicians Association Position Statement on uncompensated renal-related care for noncitizens is an excellent starting point for a framework to address this ethical dilemma. The practice of "emergent dialysis" will hopefully be found unacceptable in the future because of the fact that it is not cost effective, ethical, or humane.
Background Little is known about patterns of kidney function decline leading up to the initiation of long-term dialysis. Study Design Retrospective cohort study. Setting & Participants 5,606 Veterans ...Affairs patients who initiated long-term dialysis in 2001-2003. Predictor Trajectory of estimated glomerular filtration rate (eGFR) during the 2-year period before initiation of long-term dialysis. Outcomes & Measurements Patient characteristics and care practices before and at the time of dialysis initiation and survival after initiation. Results We identified 4 distinct trajectories of eGFR during the 2-year period before dialysis initiation: 62.8% of patients had persistently low level of eGFR <30 mL/min/1.73 m2 (mean eGFR slope, 7.7 ± 4.7 SD mL/min/1.73 m2 per year), 24.6% had progressive loss of eGFR from levels of approximately 30-59 ml/min/1.73 m2 (mean eGFR slope, 16.3 ± 7.6 mL/min/1.73 m2 per year), 9.5% had accelerated loss of eGFR from levels >60 mL/min/1.73 m2 (mean eGFR slope, 32.3 ± 13.4 mL/min/1.73 m2 per year), and 3.1% experienced catastrophic loss of eGFR from levels >60 mL/min/1.73 m2 within 6 months or less. Patients with steeper eGFR trajectories were more likely to have been hospitalized and have an inpatient diagnosis of acute kidney injury. They were less likely to have received recommended predialysis care and had a higher risk of death in the first year after dialysis initiation. Conclusions There is substantial heterogeneity in patterns of kidney function loss leading up to the initiation of long-term dialysis perhaps calling for a more flexible approach toward preparing for end-stage renal disease.