Modifying diet and exercise in multiple sclerosis (MoDEMS): A randomized controlled trial for behavioral weight loss in adults with multiple sclerosis and obesity.

BACKGROUND: Obesity is a risk factor for developing multiple sclerosis (MS) and MS-related disability. The efficacy of behavioral weight loss interventions among people with MS (pwMS) remains largely unknown. OBJECTIVE: Examine whether a group-based telehealth weight loss intervention produces clinically significant weight loss in pwMS and obesity. METHODS: Seventy-one pwMS were randomized to the weight loss intervention or treatment-as-usual (TAU). The 6-month program promoted established guidelines for calorie reduction and increased physical activity. Anthropometric measurements, mobility tasks, self-report questionnaires, and accelerometry were used to assess changes at follow-up. RESULTS: Mean percent weight loss in the treatment group was 8.6% compared to 0.7% in the TAU group (p < .001). Sixty-five percent of participants in the intervention achieved clinically meaningful weight loss (⩾ 5%). Participants in the treatment group engaged in 46.2 minutes/week more moderate-to-vigorous physical activity than TAU participants (p = .017) and showed improvements in quality of life (p = .012). Weight loss was associated with improved mobility (p = .003) and reduced fatiguability (p = .008). CONCLUSION: Findings demonstrate the efficacy of a behavioral intervention for pwMS and obesity, with clinically significant weight loss for two-thirds of participants in the treatment condition. Weight loss may also lead to improved mobility and quality of life.

Factors associated with change over time in quality of life of people with dementia: longitudinal analyses from the MODEM cohort study.

BACKGROUND: Research to date offers mixed evidence about the relationship between quality of life and severity of cognitive impairment in people with dementia. We aimed to investigate longitudinal changes in patient- and proxy-rated health-related quality of life (HRQL) by severity of dementia and explore factors associated with changes in HRQL over a one-year period. We used data from the MODEM longitudinal cohort study which recruited dyads of persons with clinically diagnosed dementia and their principal carer and interviewed them face-to-face at baseline and again 1 year later. METHODS: Quota sampling was used to generate balanced numbers (target n = 100 for each severity level) of people with mild cognitive impairment (20+ on the standardised Mini-Mental State Examination (sMMSE)), moderate cognitive impairment (score 10 to 19), and severe cognitive impairment (score 0 to 9). Persons with dementia without an identifiable family carer or other informant (e.g., a formal/professional/paid carer) were excluded from the study. Participants answered a series of questions measuring their HRQL: DEMQOL, DEMQOL-proxy, EQ-5D-3 L, EQ-5D-3L proxy. Multiple regression models were built to understand the effects of baseline demographics and dementia symptoms (cognitive impairment, neuropsychiatric symptoms) on change in HRQL over 1 year. RESULTS: Two hundred and forty-three dyads of people with clinically diagnosed dementia and carers completed baseline and follow-up interviews. Most measures of HRQL remaining relatively stable between time-points, but one index of HRQL, EQ-5D proxy, significantly declined. Depending on the HRQL measure, different factors were associated with change in HRQL. The only factor consistently associated with decline in HRQL (when compared to improvement) was having a diagnosis of a non-Alzheimer's dementia. CONCLUSIONS: Deterioration in HRQL is not an inevitable part of the dementia journey. However, people with non-Alzheimer's dementias may be more susceptible to HRQL decline. This may indicate that those with non-Alzheimer's dementia may benefit from specific support focussed on maintaining their quality of life.

Metabolic profiles and fibrosis of nonalcoholic fatty liver disease in the elderly: A community-based study.

BACKGROUND AND AIMS: There are sparse data on the epidemiology of fatty liver in the elderly Asian population. We evaluated for predictors of fatty liver and high risk of advanced fibrosis in a community-based elderly population. METHODS: A total of 1091 participants (mean age was 74.6 ± 6.3 years) were enrolled from 2017 to 2018. Subjects with age younger than 65 years, alcoholism, and history of hepatitis B and hepatitis C were excluded. Fatty liver was diagnosed with abdominal ultrasound by using ultrasonographic fatty liver indicator, a semi-quantitative measurement grading the severity (normal, mild, and moderate-to-severe). Fibrosis-4 score was used for the prediction of the high risk of advanced fibrosis. Using a multivariable logistic regression model, we identified predictors of fatty liver and high risk of advanced fibrosis. RESULTS: In this ambulatory elderly Asian population, the prevalence of fatty liver is 41.9% and of high risk of advanced fibrosis is 12.3%. The prevalence of fatty liver decreases (44.5% to 31.8%), and the high risk of advanced fibrosis increases (3.9% to 27.0%) with aging significantly (both P < 0.05). Metabolic syndrome is a risk factor for fatty liver (odds ratio [OR], 3.19; 95% CI, 2.41-4.22) but not for high risk of advanced fibrosis (OR, 0.67; 95% CI, 0.41-1.08). Hypertriglyceridemia decreases the risk for high risk of advanced fibrosis (OR, 0.53; 95% CI, 0.33-0.87). CONCLUSION: Fatty liver is prevalent in the ambulatory elderly Asian population, affecting over 40% of this population. Age is a risk factor for high risk of advanced fibrosis, with the disease likely progressing from a steatotic to a fibrotic picture with age.

Disease severity accounts for minimal variance of quality of life in people with dementia and their carers: analyses of cross-sectional data from the MODEM study.

BACKGROUND: Due to the progressive nature of dementia, it is important to understand links between disease severity and health-related outcomes. The aim of this study is to explore the relationship between disease severity and the quality of life (QoL) of people with dementia and their family carers using a number of disease-specific and generic measures. METHODS: In the MODEM cohort study, three-hundred and seven people with clinically diagnosed dementia and their carers were recruited on a quota basis to provide equal numbers of people with mild (standardised Mini-Mental State Examination (sMMSE), n = 110), moderate (sMMSE 10-19, n = 100), and severe (sMMSE 0-9, n = 97) cognitive impairment. A series of multiple regression models were created to understand the associations between dementia severity and the QoL of people with dementia and the QoL of their carers. QoL was measured using self- (DEMQOL, EQ-5D, CASP-19) and proxy-reports (DEMQOL-Proxy, EQ-5D) of disease-specific and generic QoL of the person with dementia. Carer generic QoL was measured by self-report (EQ-5D, SF-12). RESULTS: Disease severity, as measured by the sMMSE, was not significantly associated with the QoL of the person with dementia or the carer (p > 0.05), even after controlling for potential confounding variables for self-reported instruments. Proxy measures (rated by the carer) differed systematically in that there were small, but statistically significant proportions of the variance of QoL was explained by severity of cognitive impairment in multiple adjusted models. We also found little in the way of statistically significant relationships between the QoL of people with dementia and that of their carers except between DEMQOL-Proxy scores and the carer EQ-5D scores and carer SF-12 mental sub-scores. CONCLUSIONS: The data generated supports the somewhat counterintuitive argument that severity of cognitive impairment (and therefore severity of dementia) is not associated with lower QoL for the person with dementia when self-report measures are used. However, in absolute terms, as judged by the variance in the multivariate models, it is clear that the contribution of dementia severity to the QoL of people with dementia is minimal whatever the measurement used, be it self- or proxy-rated, or disease-specific or generic.

The Integrated Health Hub (IHH) Model: The Evolution of a Community Based Primary Care and Mental Health Centre.

There is increasing demand for comprehensive community healthcare that integrates community mental health and primary care services. The Canadian Mental Health Association-Durham Branch provides an example of how the Integrated Health Hub (IHH) Model evolved organically to meet this need. The Framework Method was used to analyze interviews and focus groups with 29 participants. Results reveal five key domains critical to the development of the IHH Model (1) Communication; (2) Hub 'Nuances'; (3) Leadership; (4) Staff; and (5) Challenges. These findings provide insights for other community mental health organizations wishing to provide comprehensive integrated community healthcare services.

Experiencing meditation - Evidence for differential effects of three contemplative mental practices in micro-phenomenological interviews.

Despite increasing interest in effects of meditation, systematic in-depth research on how it qualitatively feels to engage in different kinds of contemplative practices is still missing. To fill this gap, we explore the validity of Micro-phenomenological Interviews (MpI) to assess experiences during breathing meditation (BM), observing-thought meditation (OTM), and loving-kindness meditation (LKM). We performed psycholinguistic analyses, quantitative ratings and qualitative explorations of 104 MpI (N = 57). All results reveal differential affective, bodily and sensorial fingerprints: BM-transcripts contain the most body-related vocabulary, specifically sensations in nose and abdomen. OTM-transcripts contain the most cognition-related vocabulary. OTM is experienced in head and face. LKM-transcripts contain the most vocabulary related to socio-affective processes. LKM is associated to love, sensations around the heart, and warmth. The LKM-outcomes were replicated with another independent set of MpI. These findings verify the merit of MpI as a scientific tool to gain reliable first-person data beyond questionnaires or rating scales.

Factors associated with seeking preventive dental care: an integrative model exploration of behaviors in Mexican immigrants in Midwest America.

BACKGROUND: Mexican immigrants in the United States suffer from poor oral health. The objective of the current study was to explore the utility of applying theory-based factors associated with seeking preventive dental care in a sample of Mexican American adults. METHODS: Data were collected from a cross-sectional survey of a sample of 157 people of Mexican origin (64% female; age 34 ± 11 years) recruited primarily from church congregations and lay community organizations in Central Indiana. Using the Integrative Model of Behavioral Prediction as the guiding framework, structural equation modeling was used to test factors associated with intention to seek preventive dental care. RESULTS: Attitude towards seeking preventive dental care (estimate = 0.37; p < .0001) and self-efficacy for seeking preventive dental care (estimate = 0.68; p < .0001) were associated with intention to seek preventive dental care. The association between dental beliefs and intention to seek preventive dental care was mediated by attitude and self-efficacy (indirect effect = 0.26, p = .002), and the association between past behavior and intention to seek preventive dental care was mediated by self-efficacy (indirect effect = 0.26, p = .003). CONCLUSIONS: These findings suggest that interventions to increase preventive dental care seeking behavior among Mexican Americans should focus on changing attitudes toward seeking preventive dental care and on increasing self-efficacy to seek preventive dental care. Findings also support the use of interventions to influence dental beliefs.

Two-Way Radio Modem Data Transfer for Newborn Hearing Screening Devices.

INTRODUCTION: The success of a newborn hearing screening program depends on successful tracking and follow-up to ensure that children who have had positive screening results in the first few days of life receive appropriate and timely diagnostic and intervention services. The easy availability, through a suitable infrastructure, of the data necessary for the tracking, diagnosis, and care of children concerned is a major key to enhancing the quality and efficiency of newborn hearing screening programs. MATERIALS AND METHODS: Two systems for the automated two-way transmission of newborn hearing screening and configuration data, based on mobile communication technology, for the screening devices MADSEN AccuScreen® and Natus Echo-Screen® were developed and tested in a field study. Radio modem connections were compared with conventional analogue modem transmissions from Natus Echo-Screen devices for duration, transmission rate, number of lost connections, and frequency of use. RESULTS: The average session duration was significantly lower with the MADSEN AccuScreen (12 s) and Natus Echo-Screen both with radio modem (15 s) than the Natus Echo-Screen with analogue modem (108 s). The transmission rate was significantly higher (898 and 1,758 vs. 181 bytes/s) for the devices with radio modems. Both radio modem devices had significantly lower rates of broken connections after initial connection (2.1 and 0.9 vs. 5.5%). An increase in the frequency of data transmission from the clinics with mobile radio devices was found. CONCLUSIONS: The use of mobile communication technology in newborn hearing screening devices offers improvements in the average session duration, transmission rate, and reliability of the connection over analogue solutions. We observed a behavioral change in clinical staff using the new technology: the data exchange with the tracking center is more often used. The requirements for on-site support were reduced. These savings outweigh the small increase in costs for the Internet service provider.

A computational model of lysosome-ER Ca2+ microdomains.

Acidic organelles form an important intracellular Ca(2+) pool that can drive global Ca(2+) signals through coupling with endoplasmic reticulum (ER) Ca(2+) stores. Recently identified lysosome-ER membrane contact sites might allow formation of Ca(2+) microdomains, although their size renders observation of Ca(2+) dynamics impractical. Here, we generated a computational model of lysosome-ER coupling that incorporated a previous model of the inositol trisphosphate (IP3) receptor as the ER Ca(2+) 'amplifier' and lysosomal leaks as the Ca(2+) 'trigger'. The model qualitatively described global Ca(2+) responses to the lysosomotropic agent GPN, which caused a controlled but substantial depletion of small solutes from the lysosome. Adapting this model to physiological lysosomal leaks induced by the Ca(2+) mobilising messenger NAADP demonstrated that lysosome-ER microdomains are capable of driving global Ca(2+) oscillations. Interestingly, our simulations suggest that the microdomain [Ca(2+)] need not be higher than that in the cytosol for responses to occur, thus matching the relatively high affinity of IP3 receptors for Ca(2+). The relative distribution and overall density of the lysosomal leaks dictated whether microdomains triggered or modulated global signals. Our data provide a computational framework for probing lysosome-ER Ca(2+) dynamics.

[Influence of Meyer Saklad's Lectures on the Development of Modem Anesthesiology in Japan -An Assessment of their Influence on the Publication of Special Issues on Anesthesiology in Japanese Medical Journals.]

Modern anesthesiology in Japan developed after Meyer Sakad's lectures at the Japanese-American Joint Conference on Medical Education (JAJCME) in 1950. To assess their influence on the subsequent advance in the specialty, the author surveyed Japanese clinical journals between 1949 and 1953 to find special issues on anesthesiology. Only two special issues were found in the journals published in March 1951 and February 1953. Because the former issue in the jour- nal "Rinsho" was published before Maeda's presidential address in 1951 at the Annual Meeting of the 51st Japan Surgical Society and Volpitto's lectures at the second JAJCME in 1952, the influence of Maeda's and Volpitto's lectures is excluded from this issue. The traces of Saklad's influence are detected only in two articles by Shimizu et al and Maeda et al, who enjoyed Saklad's lectures.

Path induced coherent energy transfer in light-harvesting complexes in purple bacteria.

Features of path dependent energy transfer in a dual-ring light-harvesting (LH2) complexes (B850) system have been examined in detail systematically. The Frenkel-Dirac time dependent variational method with the Davydov D1 Ansatz is employed with detailed evolution of polaron dynamics in real space readily obtained. It is found that the phase of the transmission amplitude through the LH2 complexes plays an important role in constructing the coherent excitonic energy transfer. It is also found that the symmetry breaking caused by the dimerization of bacteriochlorophylls and coherence or correlation between two rings will be conducive in enhancing the exciton transfer efficiency.

Benthic microbial fuel cell as direct power source for an acoustic modem and seawater oxygen/temperature sensor system.

Supported by the natural potential difference between anoxic sediment and oxic seawater, benthic microbial fuel cells (BMFCs) promise to be ideal power sources for certain low-power marine sensors and communication devices. In this study a chambered BMFC with a 0.25 m(2) footprint was used to power an acoustic modem interfaced with an oceanographic sensor that measures dissolved oxygen and temperature. The experiment was conducted in Yaquina Bay, Oregon over 50 days. Several improvements were made in the BMFC design and power management system based on lessons learned from earlier prototypes. The energy was harvested by a dynamic gain charge pump circuit that maintains a desired point on the BMFC's power curve and stores the energy in a 200 F supercapacitor. The system also used an ultralow power microcontroller and quartz clock to read the oxygen/temperature sensor hourly, store data with a time stamp, and perform daily polarizations. Data records were transmitted to the surface by the acoustic modem every 1-5 days after receiving an acoustic prompt from a surface hydrophone. After jump-starting energy production with supplemental macroalgae placed in the BMFC's anode chamber, the average power density of the BMFC adjusted to 44 mW/m(2) of seafloor area which is better than past demonstrations at this site. The highest power density was 158 mW/m(2), and the useful energy produced and stored was ≥ 1.7 times the energy required to operate the system.

On the asymptotic behavior of the average geodesic distance L and the compactness CB of simple connected undirected graphs whose order approaches infinity.

The average geodesic distance L Newman (2003) and the compactness CB Botafogo (1992) are important graph indices in applications of complex network theory to real-world problems. Here, for simple connected undirected graphs G of order n, we study the behavior of L(G) and CB(G), subject to the condition that their order |V(G)| approaches infinity. We prove that the limit of L(G)/n and CB(G) lies within the interval [0;1/3] and [2/3;1], respectively. Moreover, for any not necessarily rational number ß ∈ [0;1/3] (α ∈ [2/3;1]) we show how to construct the sequence of graphs {G}, |V(G)| = n → ∞, for which the limit of L(G)/n (CB(G)) is exactly ß (α) (Theorems 1 and 2). Based on these results, our work points to novel classification possibilities of graphs at the node level as well as to the information-theoretic classification of the structural complexity of graph indices.

Modifying Diet and Exercise in MS (MoDEMS): Study design and protocol for a telehealth weight loss intervention for adults with obesity & Multiple Sclerosis.

Weight loss improves overall health, and reduces inflammation, risk of stroke, heart attack, diabetes, certain cancers, and death among individuals with obesity. Weight loss also improves mobility, increases stamina, and elevates mood. Between 25 and 33% of people with Multiple Sclerosis (pwMS) have obesity. Multiple Sclerosis (MS) and obesity are independently associated with reduced mobility, increased fatigue, and depression. Most behavioral weight loss trials exclude individuals with neurologic disease. Consequently, few studies have examined the effects of weight loss on symptom presentation and health outcomes among pwMS and obesity. This is the first study examining the efficacy of a comprehensive behavioral weight loss intervention designed specifically for pwMS. The purpose of this study is to develop and assess the efficacy of a telehealth administered weight loss intervention tailored for pwMS. Additionally, we aim to determine if weight loss reduces physical and emotional symptoms in individuals with obesity and MS. We will enroll 70 pwMS in a wait-list crossover trial to examine the efficacy of our intervention. If successful, findings will help determine whether we can help participants lose clinically significant weight - and whether weight loss among pwMS and overweight/obesity reduces fatigue, and improves mobility, mood, and quality of life.

Planning for Internet connectivity in remote patient monitoring.

It is important for healthcare organizations to understand the requirements and challenges of logistics when deploying remote patient monitoring (RPM) technologies in patient homes. Although most organizations prepare thoroughly for the clinical and work flow aspect of RPM solutions, they neglect to consider the logistical resources necessary to successfully manage a broad deployment. The term "logistics" in this context refers to the processes and infrastructure required to enable the use of RPM technologies in the patient's home. This article has been generated from the findings and observations of several studies where logistical objectives were included in the protocol in addition to the conventional metrics of clinical outcome, satisfaction, and economic measures. These studies implemented several high-speed Internet connectivity models with the use of wired broadband, 3G wireless, or a combination. The organizations that utilized 3G to provide Internet connectivity experienced significantly fewer logistical issues and patient frustration. It was also observed that regardless of the model, each of the clinical partners in these studies were not adequately prepared to manage Internet connectivity. Because of this, all experienced some level of difficulty installing and supporting RPM devices in the home.

Individualized Characterization of the Distribution of Collagen Fibril Dispersion Using Optical Aberrations of the Cornea for Biomechanical Models.

Purpose: The spatial distribution of collagen fibril dispersion has a significant impact on both corneal biomechanical and optical behaviors. The goal of this study was to demonstrate a novel method to characterize collagen fibril dispersion using intraocular pressure (IOP)-induced changes in corneal optical aberrations for individualized finite-element (FE) modeling. Methods: The method was tested through both numerical simulations and ex vivo experiments. Inflation tests were simulated in FE models with three assumed patterns of collagen fibril dispersion and experimentally on three rhesus monkey corneas. Geometry, matrix stiffness, and the IOP-induced changes in wavefront aberrations were measured, and the collagen fibril dispersion was characterized. An individualized corneal model with customized collagen fibril dispersion was developed, and the estimated optical aberrations were compared with the measured data. Results: For the theoretical investigations, three assumed distributions of fibril dispersion were all successfully characterized. The estimated optical aberrations closely matched the measured data, with average root-mean-square (RMS) differences of 0.29, 0.24, and 0.10 µm for the three patterns, respectively. The overall features of the IOP-induced changes in optical aberrations were estimated for two ex vivo monkey corneas, with average RMS differences of 0.57 and 0.43 µm. Characterization of the fibril dispersion in the third cornea might have been affected by corneal hydration, resulting in an increased RMS difference, 0.8 µm. Conclusions: A more advanced corneal model with individualized distribution of collagen fibril dispersion can be developed and used to improve our ability to understand both biomechanical and optical behaviors of the cornea.

Experiences and views of patients, carers and healthcare professionals on using modems in domiciliary non-invasive ventilation (NIV): a qualitative study.

BACKGROUND: Advances in technology means that domiciliary non-invasive ventilation (NIV) devices can be remotely monitored via modems in patients' homes. Possible benefits and challenges of modem technology have yet to be established. This study explored the perspectives and experiences of patients, their carers and healthcare professionals (HCPs) on the addition of modem technology in managing home NIV. METHODS: A qualitative study using a combination of focus groups for HCPs and interviews for carers/patients was undertaken. 12 HCPs and 22 patients/carers participated. These focus groups and interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS: Five main themes were identified. 'Surveillance: a paradox of findings': HCPs were concerned about unduly scrutinising patients' lives, potentially impacting on HCP patient relationships. Conversely, patients welcomed modem monitoring and did not express concerns regarding invasion of privacy. 'Sanctions': HCPs reported the modem increased access to care and allowed appropriate assessment of ongoing treatment. 'Complacency and ethics': HCPs expressed concerns patients may become complacent in seeking help due to expectations of modem monitoring, as well as being concerned regarding the ethics of modems. There was a suggestion patients and carers' expectations of monitoring were different to that of clinical practice, resulting in complacency in some cases. 'Increased time for patient focused care': HCPs in the focus groups described a number of ways in which using modems was more efficient. 'Confidence: can be improved with technology': patients and carers were positive about the impact of the modems on their health and well-being, particularly their confidence. CONCLUSION: HCPs expressed concerns about surveillance were not corroborated by patients, suggesting acceptability of remote monitoring. Data suggests a need for increased clarity to patients/carers regarding clinical practice relating to responsiveness to modem data. The issue of complacency requires further consideration. Modem technology was acceptable and considered a useful addition by HCPs, patients and carers. TRIAL REGISTRATION NUMBER: NCT03905382.

Design of an acoustic telemetry system for rebreathers.

Despite the abundance of telemetric applications for ecology, behavior and physiology of marine life, few efforts were reported about the use of acoustic telemetry for SCUBA divers. The objective of this study is to design and test an acoustic telemetry system for monitoring breathing gases of a Dräger Dolphin semi-closed circuit rebreather as well as the depth of the diver. The system is designed around a PC based surface unit and a microcontroller based diver carried module that digitizes the output of CO2 and O2 sensors located in the inhalation side of the canister. One pair of acoustic modems establishes the data link between the microcontroller and the topside PC. The graphical user interface is written in C# and enables the recording of the diving session as well. The system is calibrated in a hyperbaric chamber and tested successfully with four dives in three different environments using 100% O2 and Nitrox (47.9% O2 - 52.1% N2) up to 15 m depth and a distance of 40 m between acoustic modems. The telemetry data cannot be used only for recording physiological data but also provides an important operational safety tool to monitor the rebreather user. The future designs will include actuators for controlling the diluent and oxygen flow to closed circuit mix gas rebreathers.

Enabling Ultrasound In-Body Communication: FIR Channel Models and QAM Experiments.

Ultrasound waves pose a promising alternative to the commonly used electromagnetic waves for intra-body communication. This due to the lower ultrasound wave attenuation, the reduced health risks, and the reduced external interference. Current state-of-the-art ultrasound designs, however, are limited in their practical in-body deployment and reliability. This stems from their use of bulky, focused transducers, the use of simple modulation schemes or the absence of a realistic test environment and corresponding realistic channel models. Therefore, this paper proposes a new, ultrasound, static emulation test bed consisting of small, omnidirectional transducers, and custom gelatin phantoms with additional scattering materials. Using this test bed, we investigate different in-body communication scenarios. Multiple communication channels were extracted and mapped onto finite impulse response (FIR) channel models, which are verified and open sourced for future research. Furthermore, a basic quadrature-amplitude modulation (QAM) modem was built to assess the communication performance under various modulation schemes. A link was established using 4-QAM and 200 kbit/s resulting in a BER <1e-4 at received Eb/No of 13dB. Identical results were obtained by computer simulations on the FIR channels, which makes the extracted FIR channels suitable for the design of future ultrasound in-body communication schemes.