Feasibility and acceptability of a technology-based, rural weight management intervention in older adults with obesity.

BACKGROUND: Older adults with obesity residing in rural areas have reduced access to weight management programs. We determined the feasibility, acceptability and preliminary outcomes of an integrated technology-based health promotion intervention in rural-living, older adults using remote monitoring and synchronous video-based technology. METHODS: A 6-month, non-randomized, non-blinded, single-arm study was conducted from October 2018 to May 2020 at a community-based aging center of adults aged ≥65 years with a body mass index (BMI) ≥30 kg/m2. Weekly dietitian visits focusing on behavior therapy and caloric restriction and twice-weekly physical therapist-led group strength, flexibility and balance training classes were delivered using video-conferencing to participants in their homes. Participants used a Fitbit Alta HR for remote monitoring with data feedback provided by the interventionists. An aerobic activity prescription was provided and monitored. RESULTS: Mean age was 72.9±3.9 years (82% female). Baseline anthropometric measures of weight, BMI, and waist circumference were 97.8±16.3 kg, 36.5±5.2 kg/m2, and 115.5±13.0 cm, respectively. A total of 142 participants were screened (n=27 ineligible), and 53 consented. There were nine dropouts (17%). Overall satisfaction with the trial (4.7+ 0.6, scale: 1 (low) to 5 (high)) and with Fitbit (4.2+ 0.9) were high. Fitbit was worn an average of 81.7±19.3% of intervention days. In completers, mean weight loss was 4.6±3.5 kg or 4.7±3.5% (p< 0.001). Physical function measures of 30-s sit-to-stand repetitions increased from 13.5±5.7 to 16.7±5.9 (p< 0.001), 6-min walk improved by 42.0±77.3 m (p=0.005) but no differences were observed in gait speed or grip strength. Subjective measures of late-life function improved (3.4±4.7 points, p< 0.001). CONCLUSIONS: A technology-based obesity intervention is feasible and acceptable to older adults with obesity and may lead to weight loss and improved physical function. CLINICAL TRIAL REGISTRATION: Registered on Clinicaltrials.gov # NCT03104205 . Registered on April 7, 2017. First participant enrolled on October 1st, 2018.

Intensive nutrition counseling as part of a multi-component weight loss intervention improves diet quality and anthropometrics in older adults with obesity.

BACKGROUND AND AIMS: Obesity significantly impacts older adults. Intensive nutrition counseling can aid in weight reduction and improve diet quality, but data are sparse in this population. The objective of this intervention is to determine how intensive nutrition counseling affects diet quality and anthropometric measures during a multi-component weight loss intervention in rural older adults with obesity. METHODS: A series of 12-week, single-arm feasibility pilots were conducted in fall 2017 and winter/spring 2018 in a community aging center in rural Northern New England. Adults were eligible if ≥ 65 years old with a Body Mass Index (BMI) ≥30 kg/m2. Exclusion criteria included dementia/cognitive impairment, uncontrolled psychiatric illness, weight-loss surgery, weight loss >5% in previous 6-months, life-threatening illness, palliative/hospice services, current participation in another weight-loss study/program, obesogenic medications, or presence of major chronic conditions. Participants received once-weekly nutrition counseling by a registered dietitian nutritionist (RDN), and twice-weekly exercise sessions by a physical therapist (PT). Primary outcomes were diet quality changes measured by total Rapid Eating and Activity Assessment for Patients-Short Version (REAP-S) and Automated Self-Administered 24-h dietary recall (ASA-24). Secondary outcome measures were changes in weight (kilograms) and waist circumference (centimeters). McNemar test was conducted for all paired categorical data while paired t-tests were conducted for all paired continuous data. All analyses were conducted in R; p-value<0.05 was significant. RESULTS: Total n = 23. Mean age was 72.2 (5.8) years (73.9% female); mean BMI was 35.9 ± 5.0 kg/m2. At 12 weeks, diet quality significantly improved. REAP-S scores increased by 3.53 ± 3.13 points (p < 0.001). Kilocalories, grams fat, grams saturated fat, milligrams sodium, grams added sugar, and grams alcohol via ASA-24 significantly decreased (all p < 0.05). Significant reductions in weight (-5.22 ± 3.13 kg) and waist circumference (-6.88 ± 5.67 cm) were observed (both p < 0.001). CONCLUSION: Intensive nutrition counseling significantly enhances diet quality and reduces weight and waist circumference in rural older adults with obesity.

Stretched arc discharge in produced water.

The objective of the present study was to investigate the feasibility of stretching an arc discharge in produced water to increase the volume of produced water treated by plasma. Produced water is the wastewater generated by hydraulic fracturing of shale during the production phase in shale-oil or shale-gas exploration. The electric conductivity of produced water is in the range of 50-200 mS/cm, which provides both a challenge and opportunity for the application of plasmas. Stretching of an arc discharge in produced water was accomplished using a ground electrode and two high-voltage electrodes: one positioned close to the ground electrode and the other positioned farther away from the ground. The benefit of stretching the arc is that the contact between the arc and water is significantly increased, resulting in more efficient plasma treatment in both performance and energy cost.

Driving phase slips in a superfluid atom circuit with a rotating weak link.

We have observed well-defined phase slips between quantized persistent current states around a toroidal atomic (23Na) Bose-Einstein condensate. These phase slips are induced by a weak link (a localized region of reduced superfluid density) rotated slowly around the ring. This is analogous to the behavior of a superconducting loop with a weak link in the presence of an external magnetic field. When the weak link is rotated more rapidly, well-defined phase slips no longer occur, and vortices enter into the bulk of the condensate. A noteworthy feature of this system is the ability to dynamically vary the current-phase relation of the weak link, a feature which is difficult to implement in superconducting or superfluid helium circuits.

Longer mean colonoscopy withdrawal time is associated with increased adenoma detection: evidence from the Bowel Cancer Screening Programme in England.

BACKGROUND AND STUDY AIMS: Increasing colonoscopy withdrawal time (CWT) is thought to be associated with increasing adenoma detection rate (ADR). Current English guidelines recommend a minimum CWT of 6 minutes. It is known that in the Bowel Cancer Screening Programme (BCSP) in England there is wide variation in CWT. The aim of this observational study was to examine the relationship between CWT and ADR. PATIENTS AND METHODS: The study examined data from 31 088 colonoscopies by 147 screening program colonoscopists. Colonoscopists were grouped in four levels of mean CWT ( < 7, 7 - 8.9, 9 - 10.9, and ≥ 11 minutes). Univariable and multivariable analysis (binary logistic and negative binomial regression) were used to explore the relationship between CWT, ADR, mean number of adenomas and number of right-sided and advanced adenomas. RESULTS: In colonoscopists with a mean CWT < 7 minutes, the mean ADR was 42.5 % compared with 47.1 % in the ≥ 11-minute group (P < 0.001). The mean number of adenomas detected per procedure increased from 0.77 to 0.94, respectively (P < 0.001). The increase in adenoma detection was mainly of subcentimeter or proximal adenomas; there was no increase in the detection of advanced adenomas. Regression models showed an increase in ADR from 43 % to 46.5 % for mean CWT times ranging from 6 to 10 minutes. CONCLUSIONS: This study demonstrates that longer mean withdrawal times are associated with increasing adenoma detection, mainly of small or right-sided adenomas. However, beyond 10 minutes the increase in ADR is minimal. Mean withdrawal times longer than 6 minutes are not associated with increased detection of advanced adenomas. Withdrawal time remains an important quality metric of colonoscopy.

Modelling the hierarchical structure in datasets with very small clusters: a simulation study to explore the effect of the proportion of clusters when the outcome is continuous.

In cluster-randomised trials, the problem of non-independence within clusters is well known, and appropriate statistical analysis documented. Clusters typically seen in cluster trials are large in size and few in number, whereas datasets of preterm infants incorporate clusters of size two (twins), size three (triplets) and so on, with the majority of infants being in 'clusters' of size one. In such situations, it is unclear whether adjustment for clustering is needed or even possible. In this paper, we compared analyses allowing for clustering (linear mixed model) with analyses ignoring clustering (linear regression). Through simulations based on two real datasets, we explored estimation bias in predictors of a continuous outcome in different size datasets typical of preterm samples, with varying percentages of twins. Overall, the biases for estimated coefficients were similar for linear regression and mixed models, but the standard errors were consistently much less well estimated when using a linear model. Non-convergence was rare but was observed in approximately 5% of mixed models for samples below 200 and percentage of twins 2% or less. We conclude that in datasets with small clusters, mixed models should be the method of choice irrespective of the percentage of twins. If the mixed model does not converge, a linear regression can be fitted, but standard error will be underestimated, and so type I error may be inflated.

Superflow in a toroidal Bose-Einstein condensate: an atom circuit with a tunable weak link.

We have created a long-lived (≈40 s) persistent current in a toroidal Bose-Einstein condensate held in an all-optical trap. A repulsive optical barrier across one side of the torus creates a tunable weak link in the condensate circuit, which can affect the current around the loop. Superflow stops abruptly at a barrier strength such that the local flow velocity at the barrier exceeds a critical velocity. The measured critical velocity is consistent with dissipation due to the creation of vortex-antivortex pairs. This system is the first realization of an elementary closed-loop atom circuit.

Sculpting the vortex state of a spinor BEC.

We use Raman-detuned laser pulses to achieve spatially varying control of the amplitude and phase of the spinor order parameter of a Bose-Einstein condensate. We present experimental results confirming precise radial and azimuthal control of amplitude and phase during the creation of vortex-antivortex superposition states.

Creation and detection of Skyrmions in a Bose-Einstein condensate.

We present the first experimental realization and characterization of two-dimensional Skyrmions and half-Skyrmions in a spin-2 Bose-Einstein condensate. The continuous rotation of the local spin of the Skyrmion through an angle of pi (and half-Skyrmion through an angle of pi/2) across the cloud is confirmed by the spatial distribution of the three spin states as parametrized by the bending angle of the l vector. The winding number w = (0,1,2) of the internal spin states comprising the Skyrmions is confirmed through matter-wave interference.

New retrievable coil anchors: preliminary in vivo experiences in swine.

PURPOSE: To design and test retrievable coil anchors to improve the safety and efficacy of coil embolization. METHODS: Fifty-two 0.038-inch homemade retrievable stainless steel coils were equipped with one of four different pre-shaped nitinol anchors and tested in 38 pigs. All coils with the anchor were completely retrieved and redeployed 3-18 times (median 7 times) prior to release. Types 1 and 2 anchored coils were acutely deployed in the external iliac arteries (n = 10 each), and chronically tested (1 week) in the common carotid arteries (n = 6 each). Larger type 1 (n = 4), type 3 (n = 6), and type 4 (n = 4) anchored coils were acutely deployed in the abdominal aorta. The largest type 1 anchors (n = 6) were acutely tested in the inferior vena cava. RESULTS: All anchored coils were successfully retrieved and repositioned several times. All but two coils formed a compact plug and there was no coil migration except with two mechanically defective type 3 anchors. CONCLUSION: The use of retrievable anchors allowed the coils to be retrieved and repositioned, prevented coil migration, and enabled compact coil configuration.

Creation of a transrenal arteriovenous dialysis shunt: feasibility study in a swine model.

PURPOSE: To investigate the feasibility of percutaneous renal artery and vein access for the creation of a transrenal arteriovenous hemodialysis graft. MATERIALS AND METHODS: Renal-artery-to-ipsilateral-renal-vein conduits were constructed with use of entirely percutaneous techniques in seven swine. Renal artery and vein access was performed in six animals with use of a retrograde (inside-out) technique and in one animal with use of an antegrade (outside-in) technique. Modified 8-F sheaths were used in the first three animals and Wallgrafts were used in the final four animals to form the arterial and venous limbs of each shunt. The arterial and venous limbs were joined together by a subcutaneous segment of 6-mm reinforced polytetrafluoroethylene (PTFE) in five animals and by external conduits in two animals. Wallgrafts were deployed from the renal artery and vein into the segments of PTFE. The free ends of each conduit were tunneled and joined together to close the arteriovenous circuit. Post-shunt angiography was used in all animals to document successful shunt creation and demonstrate rapid arteriovenous shunting as a determinant of technical feasibility. Two of the seven animals received additional anticoagulation therapy and/or antiplatelet therapy to prevent shunt thrombosis during the follow-up period. The three initial animals were killed within 2 hours of shunt creation, and two of the remaining four animals returned for angiographic follow-up, one on day 2 and one on day 9. All animals underwent a complete necropsy to assess for potential complications including hemorrhage and vascular or bowel injury. RESULTS: Retrograde renal arterial and venous access was successful in all six animals in which it was attempted. Five of six arterial accesses and four of six venous accesses traversed the peritoneum with two arterial accesses and one venous access penetrating a loop of large bowel. Antegrade access was performed and successfully accomplished in the final animal. Brisk arteriovenous shunting was demonstrated on completion angiography in all animals. Graft occlusion was present in the two animals that returned for follow-up and two animals died before follow-up as a result of graft leakage and subsequent hemorrhage. Minimal perinephric and intrarenal hemorrhage was demonstrated at necropsy after shunt insertion in the remaining five animals. Renal infarction was present in all kidneys used for transrenal access. CONCLUSION: The transrenal approach for the creation of a percutaneous arteriovenous shunt is feasible after renal artery and vein access by either the retrograde or antegrade technique. Additional technical refinements of the procedure and the devices used will be necessary before follow-up studies are conducted.

New embolization coil containing a nitinol wire core: preliminary in vitro and in vivo experiences.

PURPOSE: To improve the stability of the standard stainless steel embolization coil by adding a nitinol wire core. MATERIALS AND METHODS: With use of one coil with a nitinol wire core and one without one, stability and resistance to elongation were measured in vitro. Thirty-one factory-made stainless-steel macrocoils equipped with preshaped nitinol wire cores were acutely deployed into branches of the superior mesenteric artery (SMA) in five pigs (part I of the study). Fifteen homemade retrievable coils with thermal shape memory (TSM) nitinol wire cores were acutely deployed in the abdominal aortae or inferior venae cavae of four pigs (part II). Coils with a superelastic (SE) nitinol wire core (n = 9), a TSM nitinel wire core (n = 5), and without a core (n = 5) were compared in carotid embolization (part III). RESULTS: In vitro, the expansile strength of the reinforced coils was significantly greater and elongation was significantly less than the standard coils (P <.01). In part I, coils were easily deployed via diagnostic catheters. In part II, ability to reposition the coils facilitated optimal coil configuration, which resulted in effective self-anchoring and occlusion. In part III, no coils with a SE core migrated, whereas one of five with a TSM core and three of five without reinforcement migrated immediately. The core significantly increased coil stability and postplacement configuration (P <.01). CONCLUSIONS: Addition of a nitinol wire core increases the intravascular stability of the standard embolization coil by significantly enhancing expansile force and postplacement configuration. The wire core does not adversely affect the handling of the coil. The ability to reposition/retrieve the coil is a desirable feature.

Surface transformation and photoinduced recovery in CdSe nanocrystals.

CdSe nanocrystals in solution and films can enter a metastable state in which the highly luminescent nanocrystals become dark. This change, which we attribute to a surface transformation, can be caused by heating or by changing the environment of the nanocrystals at room temperature. The metastable transformation is reversed upon illumination of above-band-gap light, at which point the nanocrystals are again highly luminescent.

Iatrogenic Horner's syndrome in an experimental pig.

An adult domestic female pig (Sus scrofa) exhibited clinical signs of right-sided Horner's syndrome after experimental placement of a woven aortic stent followed by aortic catheterization. The clinical signs included a miotic pupil, ptosis of the upper eyelid, prolapse of the nictitating membrane, and enophthalmos. Necropsy revealed a large mass in the right midcervical region that encased or was in contact with the carotid artery, internal jugular vein, and vagus nerve. Closer evaluation of the mass revealed that it was a small piece of surgical suture material that was embedded within the lumen of the carotid artery. This extrinsic material served as a nidus for an inflammatory reaction involving the vagus nerve.

A double coaxial delivery system for deployment of a two-stage stent-graft. An experimental feasibility study.

PURPOSE: To design and test a delivery system for successive, rapid two-stage deployment of an aortic stent graft. MATERIAL AND METHODS: An aortic stent graft was made that consisted of two separate parts. A delivery system composed of two independent coaxial mechanisms was fabricated and used to deploy the stages of the graft in dogs' aortas. RESULTS: Delivery was successful in all four dogs, and required less than 2 min in each animal. CONCLUSION: The double coaxial delivery system enabled quick endovascular assembly of a two-stage aortic stent-graft.

Animal models for atherosclerosis, restenosis, and endovascular graft research.

Animal models have significantly advanced our understanding of the mechanisms of atherosclerosis and restenosis formation and the evaluation of therapeutic options. The current focus of research is on preventive strategies against restenosis and includes pharmacologic and biologic interventions directed primarily against smooth muscle cell proliferation, endovascular devices for recanalization and/or drug delivery, and an integrated approach using both devices and pharmacobiologic agents. Devices aimed at the percutaneous endoluminal exclusion of aortic aneurysms have also generated interest recently. The experience over many decades with animal models in vascular research has established that a single, ideal, naturally available model for atherosclerosis, restenosis, or for that matter aneurysm formation, does not exist. Presently, rabbits and pigs are favored for the former two areas of study, and dogs and sheep appear to provide suitable models for testing devices for endoluminal repair of aneurysms. The development of transgenic variants of currently available models may widen our options in the future. Nevertheless, an appreciation of the individual features of natural or stimulated disease in each species is of the utmost importance for the proper design and execution of relevant experiments.

Experimental evaluation of cellulose acetate NF and ethylene-vinyl alcohol copolymer for selective arterial embolization.

PURPOSE: Studies were conducted in rabbits to evaluate two new liquid polymeric compounds developed for selective arterial embolization. MATERIALS AND METHODS: The compounds consisted of cellulose acetate NF (Embolyx C) or ethylene-vinyl alcohol copolymer (Embolyx E) dissolved in anhydrous dimethyl sulfoxide (DMSO) containing 30% tantalum powder. Acute renal embolization was performed to determine an optimal method of administration and level of embolization. Kidneys were embolized with and without flow around the catheter. DMSO was also injected in the same manner. Tissue sections were examined radiographically and microscopically. Tumor embolization was performed to evaluate the efficacy of the polymers and compare their embolic effects with polyvinyl alcohol (PVA) particles and gelatin sponge (Gelfoam) powder. An embolic agent, saline, or DMSO was injected into the deep femoral artery feeding an intramuscular VX2 carcinoma. Animals were followed up for 3 weeks. RESULTS: Viscosity and administration technique affected polymer distribution and depth of penetration. Embolization with the test polymers was quicker and more easily achieved than with PVA or Gelfoam, and no recanalization occurred. Both polymers were as effective as PVA particles for tumor ablation, but DMSO caused some vascular damage. CONCLUSION: Although use of DMSO has some drawbacks, the results of this study warrant further investigation of the Embolyx polymers for tumor embolization.

Preliminary results with a new vascular basket occluder in swine.

PURPOSE: To experimentally evaluate a new self-anchoring vascular occlusion device suitable for use in large, high-flow vessels. MATERIALS AND METHODS: A basket-shaped occluding device consisting of a nitinol frame (with or without polyester threads) covered with Dacron was evaluated in the common iliac arteries and abdominal aortae of normal pigs. One occluder was placed in each recipient vessel. Angiography was performed before and after placement of each occluder. RESULTS: Precise placement of the device was achieved in all cases. Mechanically, all but one occluder worked dependably. Angiographically, devices without polyester threads produced only partial occlusion. Devices with threads produced complete occlusion in all but one abdominal aorta, in which partial occlusion occurred because the occluder opened asymmetrically. Complete iliac arterial occlusion occurred within 2-8 minutes of placement and aortic occlusion was achieved within 8-20 minutes. At necropsy, all devices were found to be securely anchored against the vascular wall. CONCLUSION: Preliminary results indicate that this vascular basket occluder containing polyester threads is easy to place precisely, produces rapid embolization, and demonstrates good self-anchoring ability in a high-flow arterial model.