Implementation of a digital behavior change intervention (eCHANGE) for weight loss maintenance support: a service design and technology transfer approach.

Obesity is a chronic disease, and while weight loss is achievable, long-term weight loss maintenance is difficult and relapse common for people living with obesity. Aiming to meet the need for innovative approaches, digital behavior change interventions show promise in supporting health behavior change to maintain weight after initial weight loss. Implementation of such interventions should however be part of the design and development processes from project initiation to facilitate uptake and impact. Based on the development and implementation process of eCHANGE, an evidence-informed application-based self-management intervention for weight loss maintenance, this manuscript provides suggestions and guidance into; (1) How a service design approach can be used from initiation to implementation of digital interventions, and (2) How a technology transfer process can accelerate implementation of research-based innovation from idea to market.

Reducing global turbulent resistivity by eliminating large eddies in a spherical liquid-sodium experiment.

Three-wave turbulent interactions and the role of eddy size on the turbulent electromotive force are studied in a spherical liquid-sodium dynamo experiment. A symmetric, equatorial baffle reduces the amplitude of the largest-scale turbulent eddies, which is inferred from the magnetic fluctuations spectrum (measured by a 2D array of surface probes). Differential rotation in the mean flow is >2 times more effective in generating mean toroidal magnetic fields from the applied poloidal field (via the Ω effect) when the largest-scale eddies are eliminated, thus demonstrating that the global turbulent resistivity (the ß effect from the largest-scale eddies) is reduced by a similar amount.

Associations among binge eating behavior patterns and gastrointestinal symptoms: a population-based study.

BACKGROUND: The psychological symptoms associated with binge eating disorder (BED) have been well documented. However, the physical symptoms associated with BED have not been explored. Gastrointestinal (GI) symptoms such as heartburn and diarrhea are more prevalent in obese adults, but the associations remain unexplained. Patients with bulimia have increased gastric capacity. The objective of the study was to examine if the severity of binge eating episodes would be associated with upper and lower GI symptoms. METHODS: Population-based survey of community residents through a mailed questionnaire measuring GI symptoms, frequency of binge eating episodes and physical activity level. The association of GI symptoms with frequency of binge eating episodes was assessed using logistic regression models adjusting for age, gender, body mass index (BMI) and physical activity level. RESULTS: In 4096 subjects, BED was present in 6.1%. After adjusting for BMI, age, gender, race, diabetes mellitus, socioeconomic status and physical activity level, BED was independently associated with the following upper GI symptoms: acid regurgitation (P<0.001), heartburn (P<0.001), dysphagia (P<0.001), bloating (P<0.001) and upper abdominal pain (P<0.001). BED was also associated with the following lower GI symptoms: diarrhea (P<0.001), urgency (P<0.001), constipation (P<0.01) and feeling of anal blockage (P=0.001). CONCLUSION: BED appears to be associated with the experience of both upper and lower GI symptoms in the general population, independent of the level of obesity. The relationship between increased GI symptoms and physiological responses to increased volume and calorie loads, nutritional selections and rapidity of food ingestion in individuals with BED deserves further study.

Magmatic resurgence in long valley caldera, california: possible cause of the 1980 mammoth lakes earthquakes.

Changes in elevation between 1975 and October 1980 along a leveling line across the Long Valley caldera indicate a broad (half-width, 15 kilometers) uplift (maximum, 0.25 meter) centered on the old resurgent dome. This uplift is consistent with reinflation of a magma reservoir at a depth of about 10 kilometers. Stresses generated by this magmatic resurgence may have caused the sequence of four magnitude 6 earthquakes near Mammoth Lakes in May 1980.

The 1984 morgan hill, california, earthquake.

The Morgan Hill, California, earthquake (magnitude 6.1) of 24 April 1984 ruptured a 30-kilometer-long segment of the Calaveras fault zone to the east of San Jose. Although it was recognized in 1980 that an earthquake of magnitude 6 occurred on this segment in 1911 and that a repeat of this event might reasonably be expected, no short-term precursors were noted and so the time of the 1984 earthquake was not predicted. Unilateral rupture propagation toward the south-southeast and an energetic late source of seismic radiation located near the southeast end of the rupture zone contributed to the highly focused pattern of strong motion, including an exceptionally large horizontal acceleration of 1.29g at a site on a dam abutment near the southeast end of the rupture zone.

First Report of Fludioxonil-Resistant Isolates of Fusarium spp. Causing Potato Seed-Piece Decay.

Potato (Solanum tuberosum L.) diseases incited by Fusarium spp. include postharvest dry rot and seed-piece decay. Fusarium seed-piece decay is commonly controlled by preplant applications of chemical seed treatments. However, isolates of Fusarium spp. resistant to benzimidazole fungicides have been reported (2,4). In the spring of 2007, samples of cut seed tubers (cvs. Shepody and Russet Burbank) showing extensive symptoms of decay were received from three seedlots in Prince Edward Island (PE) and one seedlot in Saskatchewan (SK), Canada. All seed tubers had been treated with fludioxonil (Maxim Potato Seed Protectant [PSP], 0.5% fludioxonil) following cutting and then stored for 10 to 14 days prior to planting. Using standard isolation protocols (4), the 19 potato tuber pieces examined from PE and 2 from SK yielded 21 Fusarium isolates for further study. Five isolates (including both isolates from SK) were identified as Fusarium sambucinum Fuckel and the remaining 16 isolates were identified as F. coeruleum (Libert) Sacc. (3). To confirm identifications, isolates were compared with two known standards of each of F. sambucinum and F. coeruleum identified by K. Seifert (Agriculture and Agri-Food Canada, Ottawa, ON) by DNA sequencing of the partial ß-tubulin gene or the translation elongation factor 1-α ( http://fusarium.cbio.psu.edu ; [1]). These standard isolates were also used as fludioxonil-sensitive controls in amended agar assays for chemical sensitivity. Agar plugs (5 mm in diameter) taken from the margins of 7-day-old cultures of the Fusarium isolates were transferred to petri dishes containing ½-strength potato dextrose agar amended with 0, 0.1, 1.0, 10.0, or 100.0 mg/liter of fludioxonil. Fludioxonil (Maxim PSP, 0.5% a.i.) was prepared as a stock solution in sterile distilled water and added to the molten agar after autoclaving. Culture incubation and mycelial growth measurements were performed as described previously (4). Measurements from four replicate petri dishes per concentration of fludioxonil were taken. Calculated EC50 values (fludioxonil concentration inhibiting pathogen growth by 50%) were obtained. The trial was repeated three times. The two standard isolates of F. sambucinum were sensitive to fludioxonil, with mean EC50 values of 0.002 (±0.002 standard error [SE]) and 0.005 (±0.002 SE) mg/liter. The two standard isolates of F. coeruleum were also sensitive to fludioxonil, with mean EC50 values of 0.17 (±0.005 SE) and 0.19 (± 0.005 SE) mg/liter. All other tested isolates of F. sambucinum and F. coeruleum were resistant to fludioxonil and showed no growth inhibition even at 100 mg of fludioxonil per liter. To our knowledge, this is the first report of resistance to fludioxonil in isolates of Fusarium spp. causing potato seed-piece decay. Since the isolates of F. sambucinum were also resistant to thiophanate-methyl and thiabendazole (data not shown), multiclass (benzimidazole and pyrrole) resistance was also documented. References: (1) D. M. Geiser et al. Eur. J. Plant Pathol. 110:473, 2004. (2) L. M. Kawchuk et al. Am. Potato J. 71:185, 1994. (3) P. E. Nelson et al. Fusarium Species: An Illustrated Manual for Identification. Pennsylvania State University Press, 1983. (4) R. D. Peters et al. Plant Dis. 85:1030, 2001.

Extreme under-reporting of body weight by young adults with obesity: relation to social desirability.

Objective: The objective of this study was to determine whether there is an association between under-reporting of body weight and social desirability as is found with self-reports of energy intake. Methods: Twenty-seven lean individuals (mean body mass index ± standard deviation = 21.6 ± 2.0 kg m-2) and 26 individuals with obesity (mean body mass index = 35.4 ± 4.8 kg m-2) were e-mailed a questionnaire on which they had to state their body weight and conduct a home food inventory. The next day, research team members went to their homes to weigh the participants, conduct their own food inventory and administer the Marlowe-Crowne scale for social desirability. Results: Among individuals with obesity, lower social desirability scores were associated with a greater degree of under-reporting body weight (r = +0.48, p < 0.02). Among lean individuals, the correlation was negative but statistically non-significant (p = -0.22, p > 0.10). Nine individuals with obesity were extreme under-reporters (2.27 kg or more), and eight of these had social desirability scores in the bottom half of the Marlowe-Crowne scale (p < 0.01). Six under-reported on the home food inventory by three or more items. Conclusions: Individuals with obesity and low social desirability scores are more likely than others to be extreme under-reporters of body weight, possibly due to a lack of awareness of their own weight.

Prospective evaluation of the effect of ionizing radiation on the bladder tumor-associated (BTA) urine test.

PURPOSE: To prospectively evaluate the effect of ionizing radiation on the results of the bladder tumor-associated antigen (BTA) test. By examining this question, we sought to determine its potential use as a monitoring test for the detection of recurrent transitional carcinoma of the bladder in patients who have received prior radiotherapy for bladder preservation. MATERIALS AND METHODS: Between February 1996 and April 1997, 18 patients with nonbladder pelvic malignancies and no history of bladder cancer, received irradiation to the bladder. These patients were prospectively evaluated using the BTA test at the end of the external-beam radiation (EBRT) and at 3-month follow-up intervals. Urine cytology was analyzed in 16 of the 18 patients at the end of EBRT. A median of 3 separate measurements were made (range 1-6) on each patient. The median dose of EBRT was 50.4 Gy (range 30-68 Gy). Seven patients underwent brachytherapy as part of their treatment course. BTA results and time intervals were recorded and analyzed using univariate and Kaplan-Meyer methodologies. RESULTS: A total of 10 (56%) of the 18 patients had a positive BTA test at some time following completion of EBRT. Of the 10 positive tests, 9 returned to negative in a median of 42 weeks from completion of EBRT. Treatment with chemotherapy, brachytherapy, calculated bladder dose, and total external beam dose did not significantly influence either the number of positive tests or the time to resolution of the positive test in this small group of patients. All screened urine samples were negative for malignant cells and 11 (69%) of 16 showed changes consistent with ionizing radiation. CONCLUSION: Our findings support the hypothesis that ionizing radiation can cause transient positive results in the BTA test, but that these normalize with time. Although it requires further testing, it seems that the BTA test may be useful in the detection of recurrence in patients with bladder cancer who have been treated with definitive irradiation for bladder preservation.

Neurocognitive functioning and improvement in quality of life following participation in cardiac rehabilitation.

We investigated the relationship between neurocognitive functioning and quality of life/self-perceived health status (QOL) among cardiac rehabilitation (CR) patients to determine whether level of neurocognitive functioning is related to baseline QOL and improvement following CR. CR patients (n = 35) were given a neurocognitive screening before participation in CR, and also completed a behavioral inventory (SF-36) before and after CR to measure QOL associated with medical illness. At baseline, CR patients obtained relatively low SF-36 scores compared with published norms, and as reported previously, demonstrated inferior neurocognitive performance compared with healthy controls. Furthermore, neurocognitive performance was strongly positively correlated to SF-36 scores. Significant improvements were evident on many of the SF-36 subscales following rehabilitation. These improvements were relatively greater among SF-36 indexes of physical health status compared with SF-36 indexes of mental health status. Baseline neurocognitive performance also correlated strongly to the degree of improvement in SF-36 scores following rehabilitation. These findings indicate a strong relationship between baseline neurocognitive functioning and QOL before CR, and the degree to which QOL improves following this intervention.

Maintaining quality of life at the end of life.

Despite the successful growth of the hospice movement during the past 30 years in the United States, almost 85% of Americans continue to die in hospitals or nursing homes. While the benefits of palliative care principles are well established, palliative care interventions remain underused in clinical practice in the settings in which most Americans die. Our premise is that physicians as a group perpetuate end-of-life suffering rather than ease the transition from life to death. We also believe that maintaining quality of life (QOL) at the end of life requires a multidimensional approach orchestrated by physicians drawing on the full range of available physical, psychological, social, and spiritual interventions. This article defines the meaning of QOL at the end of life and then examines the ramifications of failing to attend to QOL concerns in dying patients. It reviews strategies that physicians can use to advance palliative care approaches, thereby reducing terminally ill patients' suffering in the institutions in which most die.

Prospective evaluation of Roux-en-Y gastric bypass as primary operation for medically complicated obesity.

OBJECTIVE: To determine prospectively the results of Roux-en-Y gastric bypass (RYGB) used as the primary weight-reducing operation in patients with medically complicated ("morbid") obesity. The RYGB procedure combines the advantages of a restrictive physiology (pouch of 10 mL) and a "dumping physiology" for high-energy liquids without requiring an externally reinforced (banded) stoma. PATIENTS AND METHODS: Between April 1987 and December 1998, a total of 191 consecutive patients with morbid obesity (median weight, 138 kg [range, 91-240 kg]; median body mass index, 49 kg/m2 [range, 36-74 kg/m2]), all of whom had directly weight-related morbidity, underwent RYGB and prospective follow-up. RESULTS: Hospital mortality was 0.5% (1/191), and hospital morbidity occurred in 10.5% (20/191). Good long-term weight loss was achieved, and patients adapted well to the required new eating habits. The mean +/- SD weight loss at 1 year after operation (113 patients) was 52 +/- 1 kg or 68% +/- 2% of initial excess body weight. By 3 years postoperatively (74 patients), weight loss was still 66% +/- 2% of excess body weight. Overall, 53 (72%) of 74 patients had achieved and maintained a weight loss of 50% or more of their preoperative excess body weight 3 years after the operation. In addition, only 1 (1%) of 98 patients had persistent postoperative vomiting 1 or more times per week. CONCLUSION: We believe that RYGB is a safe, effective procedure for most patients with morbid obesity and thus may be the current procedure of choice in patients requiring bariatrics++ surgery for morbid obesity.

Effects of perinatal testosterone on handedness of gerbils: support for part of the Geschwind-Galaburda hypothesis.

When assuming their species-typical tripodal stance, male Mongolian gerbils (Meriones unguiculatus) use their right forepaw for support more frequently than do females. This experiment determined whether, as N. Geschwind and A. M. Galaburda (1987) have proposed, the direction of such sexually dimorphic lateral asymmetry of forelimb use is affected by perinatal exposure to testosterone (TP). It was found that male gerbils injected with TP when 4 days old were significantly less likely to rest on their right forepaw when in a tripodal stance than were their oil-injected siblings. Female gerbils injected with TP when 6 days old were more likely than oil-injected controls to use their right forepaws for support. The findings demonstrate effects of perinatal exposure to TP on handedness in gerbils and suggest that the relationship between TP exposure and asymmetrical forelimb use is not always as direct as Geschwind and Galaburda's model suggests.

Effects of gonadectomy in infancy and adulthood on handedness in male and female Mongolian gerbils.

When assuming a species-typical tripodal posture, female Mongolian gerbils most often rest on their left forepaws and hold their right forelimbs aloft; male gerbils most often do the reverse. This experiment examined effects of gonadectomy, both in infancy and in adulthood, on the sexually dimorphic asymmetry in forelimb use by Mongolian gerbils when maintaining a tripodal stance. In adulthood, both male and female gerbils that had been gonadectomized at birth reversed their forelimb use while in a tripodal stance: Gonadectomized males used their forelimbs as did sham-operated females, and gonadectomized females used their forelimbs as did sham-operated males. Gonadectomy in adulthood abolished the sexual dimorphism in forelimb use seen in sham-operated subjects. It was concluded that gonadal hormones have organizational as well as possible activational effects on adult patterns of forelimb use by gerbils.

Intrauterine position affects motoneuron number and muscle size in a sexually dimorphic neuromuscular system.

The intrauterine position occupied by a rodent fetus influences the amount of testosterone to which it is exposed before birth. Animals that are gestated between two male fetuses (2M) are exposed to higher circulating levels of testosterone than are animals positioned between two female fetuses (2F) and there are reliable differences in the reproductive physiology and behavior of 2M and 2F animals when adult. To determine whether intrauterine position modifies development of the central nervous system, we examined the sexually dimorphic spinal nucleus of the bulbocavernosus (SNB) in male and female gerbils from known intrauterine positions. We found that adult 2M female gerbils had 16% more SNB motoneurons than did 2F females. 2M males did not differ from 2F males in SNB motoneuron number, but the bulbocavernosus muscle, which is innervated by SNB motoneurons, was approximately 50% larger in 2M than in 2F males. These data indicate that intrauterine position can influence the morphology of the sexually dimorphic SNB neuromuscular system.

Promoting physical activity in women: the new challenges.

INTRODUCTION: Participation in physical activity has important implications for the physical and psychological well-being of women. Although researchers and educators have previously focused chiefly on the promotion of vigorous activity, exercise experts have focused recently on recommendations promoting moderate activity in American adults that may have important ramifications for women. OBJECTIVES: We discuss the prevalence of activity levels among women, the barriers women encounter in becoming active, and implications for the adoption and maintenance of moderate activity. INTERVENTIONS: We present the lessons learned from theory-based intervention studies, for these findings could serve as a basis to accomplish the new objectives. CONCLUSIONS: Finally, we outline the research and policy issues that should be addressed for researchers and health educators interested in preventive health care in women.

Counseling strategies for obese patients.

Counseling strategies usually assume that an individual is ready to change; however this assumption is probably not true for many obese individuals seeking medical care. Since individuals progress through a series of stages of change, some may not yet be ready to change. The transtheoretical model of behavior change proposes that individuals move through stages of change: precontemplation, contemplation, preparation, action, and maintenance. This model has been successfully applied to a range of addictive behaviors. The application of the transtheoretical model of behavior change to obesity treatment holds promise because interventions that match treatment strategies to an individual's stage of change may be more effective than current treatments. This article reviews the potential benefits of using the transtheoretical model for weight management in the primary care setting. Medical Subject Headings (MeSH): obesity, counseling, behavior.

Increased saliva cotinine concentrations in smokers during rapid weight loss.

Although the effect of smoking cessation on weight gain is well-documented, little is known about the effect of weight loss on smoking. We examined the association between saliva cotinine levels and weight loss in a group of 9 obese female smokers during participation in a protein-sparing modified fast (Optifast). For the first 3 months of treatment, subjects consumed only the protein-sparing supplement; for the next 3 months, food was gradually reintroduced. Body mass index and saliva cotinine concentration were assessed at study entry and at 3 and 6 months. A significant weight loss was noted at 3 and 6 months, yet the cotinine level increased significantly over this time. It is unclear whether the cotinine increase is due to metabolic changes or an actual increase in nicotine intake. The results suggest that smoking-related health risks may increase during periods of significant weight loss.

Self-efficacy in weight management.

Self-efficacy is an important mediating mechanism in advancing understanding of the treatment of obesity. This study developed and validated the Weight Efficacy Life-Style Questionnaire (WEL), improving on previous studies by the use of clinical populations, cross-validation of the initial factor analysis, exploration of the best fitting theoretical model of self-efficacy, and examination of change in treatment. The resulting 20-item WEL consists of five situational factors: Negative Emotions, Availability, Social Pressure, Physical Discomfort, and Positive Activities. A hierarchical model was found to provide the best fit to the data. Results from two separate clinical treatment studies (total N = 382) show that the WEL is sensitive to changes in global scores as well as to a subset of the five situational factor scores. Treatment programs may be incomplete if they change only a subset of the situational dimensions of self-efficacy. Theoretical and clinical implications are discussed.

Theories and techniques for promoting physical activity behaviours.

The primary goal of this article is to review theoretical models utilised in designing physical activity interventions for healthy adults. Physical activity offers numerous benefits for improved physical and psychological health. However, the majority of the population is sedentary and therefore at increased risk for morbidity and mortality. Many techniques have been developed for intervening with physical activity behaviours, some of which are based on theoretical models. While some of these models show more promise than others, no model is sufficient to thoroughly explain exercise behaviours or how to best intervene. In the final section, recommendations for future research are presented, and promising areas of development in physical activity interventions are discussed. This is not an exhaustive review of theoretical models but rather focuses on models most commonly applied to physical activity.

A male gerbil's intrauterine position affects female response to his scent marks.

Female Mongolian gerbils scent marked more frequently in response to scent marks deposited by adult male conspecifics that, as fetuses, had resided in intrauterine positions between two male fetuses (2M males) than in response to scent marks deposited by adult male conspecifics that had resided in intrauterine positions between two females fetuses (2F males). Because 2M male gerbils are significantly more likely than are 2F male gerbils to impregnate females, and because female gerbils are able to discriminate among males after exposure to their scent marks, the ability of female gerbils to discriminate scent marks of 2M males from those of 2F males may serve as a basis for female identification of males likely to make suitable mates.