The Impact of Food Insecurity Rate on Bariatric Surgery Outcomes.

INTRODUCTION: Various factors impact outcomes following bariatric surgery. Lack of access to healthy food options (food insecurity [FI]) is another potential factor affecting outcomes. No prior studies have directly explored the relationship between residing in a high FI zip code and patient outcomes relating to weight loss after bariatric surgery. We hypothesized that living in a high FI zip code would be associated with decreased weight loss postsurgery. METHODS: We conducted a retrospective study with 210 bariatric surgery patients at a tertiary referral center from January to December 2020. Patient weight and body mass index (BMI) were recorded at three time points: surgery date, 1 mo, and 12 mo postoperative. Residential addresses were collected, and FI rates for the corresponding Zip Code Tabulation Areas were obtained from the 2022 Feeding America Map the Meal Gap study (2020 data). RESULTS: The FI rate showed a negative correlation of -18.3% (95% confidence interval: -35% to -0.5%; P = 0.039) with the percentage of excess weight loss (%EWL) at 1 y. In multivariate analysis, preoperative BMI (P = 0.001), presence of diabetes mellitus (P = 0.008), and bariatric procedure type (P = 0.000) were significant predictors of %EWL at 1 y. After adjusting for confounding factors, including sex, preoperative BMI, insurance status, primary bariatric procedure, and emergency department visits, the increased FI rate (P = 0.047) remained significantly associated with a decreased %EWL at 1 y. CONCLUSIONS: Residing in a high FI, Zip Code Tabulation Areas correlated with a decreased %EWL at 1 y after bariatric surgery. These findings highlight the importance of assessing FI status in pre-bariatric surgery patients and providing additional support to individuals facing FI.

Preclinical models of middle cerebral artery occlusion: new imaging approaches to a classic technique.

Stroke remains a major burden on patients, families, and healthcare professionals, despite major advances in prevention, acute treatment, and rehabilitation. Preclinical basic research can help to better define mechanisms contributing to stroke pathology, and identify therapeutic interventions that can decrease ischemic injury and improve outcomes. Animal models play an essential role in this process, and mouse models are particularly well-suited due to their genetic accessibility and relatively low cost. Here, we review the focal cerebral ischemia models with an emphasis on the middle cerebral artery occlusion technique, a "gold standard" in surgical ischemic stroke models. Also, we highlight several histologic, genetic, and in vivo imaging approaches, including mouse stroke MRI techniques, that have the potential to enhance the rigor of preclinical stroke evaluation. Together, these efforts will pave the way for clinical interventions that can mitigate the negative impact of this devastating disease.

Immersive Real-Time Biofeedback Optimized With Enhanced Expectancies Improves Motor Learning: A Feasibility Study.

CONTEXT: An Optimizing Performance through Intrinsic Motivation and Attention for Learning theory-based motor learning intervention delivering autonomy support and enhanced expectancies (EE) shows promise for reducing cognitive-motor dual-task costs, or the relative difference in primary task performance when completed with and without a secondary cognitive task, that facilitate adaptive injury-resistant movement response. The current pilot study sought to determine the effectiveness of an autonomy support versus an EE-enhanced virtual reality motor learning intervention to reduce dual-task costs during single-leg balance. DESIGN: Within-subjects 3 × 3 trial. METHODS: Twenty-one male and 24 female participants, between the ages of 18 and 30 years, with no history of concussion, vertigo, lower-extremity surgery, or lower-extremity injuries the previous 6 months, were recruited for training sessions on consecutive days. Training consisted of 5 × 8 single-leg squats on each leg, during which all participants mimicked an avatar through virtual reality goggles. The autonomy support group chose an avatar color, and the EE group received positive kinematic biofeedback. Baseline, immediate, and delayed retention testing consisted of single-leg balancing under single- and dual-task conditions. Mixed-model analysis of variances compared dual-task costs for center of pressure velocity and SD between groups on each limb. RESULTS: On the right side, dual-task costs for anterior-posterior center of pressure mean and SD were reduced in the EE group (mean Δ = -51.40, Cohen d = 0.80 and SD Δ = -66.00%, Cohen d = 0.88) compared with the control group (mean Δ = -22.09, Cohen d = 0.33 and SD Δ = -36.10%, Cohen d = 0.68) from baseline to immediate retention. CONCLUSIONS: These findings indicate that EE strategies that can be easily implemented in a clinic or sport setting may be superior to task-irrelevant AS approaches for influencing injury-resistant movement adaptations.

Unmet Needs of People with Serious Mental Illness: Perspectives from Certified Peer Specialists.

Examine the unmet needs of people with serious mental illness (SMI) from the perspective of certified peer specialists. 267 certified peer specialists from 38 states completed an online survey (female [73%], 50.9 [SD = 12] years, and non-Hispanic White [79.8%]). Many respondents reported a primary mental health diagnoses (n = 200), 22 respondents reported their diagnosis as schizophrenia spectrum disorder (11%), 46 respondents reported bipolar disorder (22.1%), 47 respondents reported major depressive disorder (22.6%), 29 respondents reported post-traumatic stress disorder (13.9%), 27 respondents reported alcohol/substance use disorder (13%), 2 respondents reported personality disorder (1%), and 12 reported "other" (5.8%). A mixed methods convergence analysis integrated quantitative with qualitative data. Social isolation (n = 160, 59.9%) and feeling lonely (n = 159, 59.6%) were the most highly endorsed unmet need, followed by the need to address chronic health conditions (n = 80, 30%), prevent mental health hospitalization (n = 71, 23.6%), and prevent drug use (n = 66, 24.7%). Four themes emerged: need to address basic necessities, loneliness and social isolation, hope, and addiction. Addressing loneliness and social isolation were identified as the primary unmet needs among people with SMI. Addressing co-morbid health conditions may simultaneously impact other unmet needs. Hope is an important intervention target. Initial insights from this study can be used to guide researchers' efforts to incorporate certified peer specialists perspectives in developing programs to meet the needs of people with SMI. Future research using participatory research methods can further examine these initial insights.

Two pathogens and one disease: detection and identification of flea-borne Rickettsiae in areas endemic for murine typhus in California.

Results of an environmental assessment conducted in a newly emergent focus of murine typhus in southern California are described. Opossums, Didelphis virginiana Kerr, infested with cat fleas, Ctenocephalides felis Buché, in the suburban area were abundant. Animal and flea specimens were tested for the DNA of two flea-borne rickettsiae, Rickettsia typhi and Rickettsia felis. R. felis was commonly detected in fleas collected throughout this area while R. typhi was found at a much lower prevalence in the vicinity of just 7 of 14 case-patient homes identified. DNA of R. felis, but not R. typhi, was detected in renal, hepatic, and pulmonary tissues of opossums. In contrast, there were no hematologic polymerase chain reaction findings of R. felis or R. typhi in opossums, rats, and cats within the endemic area studied. Our data suggest a significant probability of human exposure to R. felis in the area studied; however, disease caused by this agent is not recognized by the medical community and may be misdiagnosed as murine typhus using nondiscriminatory serologic methods.