American Society for Gastrointestinal Endoscopy-European Society of Gastrointestinal Endoscopy guideline on primary endoscopic bariatric and metabolic therapies for adults with obesity.

This joint ASGE-ESGE guideline provides an evidence-based summary and recommendations regarding the role of endoscopic bariatric and metabolic therapies (EBMTs) in the management of obesity. The document was developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. It evaluates the efficacy and safety of EBMT devices and procedures that currently have CE mark or FDA-clearance/approval, or that had been approved within five years of document development. The guideline suggests the use of EBMTs plus lifestyle modification in patients with a BMI of ≥ 30 kg/m2, or with a BMI of 27.0-29.9 kg/m2 with at least 1 obesity-related comorbidity. Furthermore, it suggests the utilization of intragastric balloons and devices for endoscopic gastric remodeling (EGR) in conjunction with lifestyle modification for this patient population.

American Society for Gastrointestinal Endoscopy-European Society of Gastrointestinal Endoscopy guideline on primary endoscopic bariatric and metabolic therapies for adults with obesity.

This joint ASGE-ESGE guideline provides an evidence-based summary and recommendations regarding the role of endoscopic bariatric and metabolic therapies (EBMTs) in the management of obesity. The document was developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. It evaluates the efficacy and safety of EBMT devices and procedures that currently have CE mark or FDA-clearance/approval, or that had been approved within five years of document development. The guideline suggests the use of EBMTs plus lifestyle modification in patients with a BMI of ≥30 kg/m2, or with a BMI of 27.0-29.9 kg/m2 with at least 1 obesity-related comorbidity. Furthermore, it suggests the utilization of intragastric balloons and devices for endoscopic gastric remodeling (EGR) in conjunction with lifestyle modification for this patient population.

Modeling effect of cover condition and soil type on rotavirus transport in surface flow.

Runoff from animal production facilities contains various microbial pathogens which pose a health hazard to both humans and animals. Rotavirus is a frequently detected pathogen in agricultural runoff and the leading cause of death among children around the world. Diarrheal infection caused by rotavirus causes more than two million hospitalizations and death of more than 500,000 children every year. Very little information is available on the environmental factors governing rotavirus transport in surface runoff. The objective of this study is to model rotavirus transport in overland flow and to compare the model results with experimental observations. A physically based model, which incorporates the transport of infective rotavirus particles in both liquid (suspension or free-floating) and solid phase (adsorbed to soil particles), has been used in this study. Comparison of the model results with experimental results showed that the model could reproduce the recovery kinetics satisfactorily but under-predicted the virus recovery in a few cases when multiple peaks were observed during experiments. Similarly, the calibrated model had a good agreement between observed and modeled total virus recovery. The model may prove to be a promising tool for developing effective management practices for controlling microbial pathogens in surface runoff.

Hydrothermal liquefaction aqueous phase mycoremediation to increase inorganic nitrogen availability.

Hydrothermal liquefaction aqueous phase (HTL-AP) is a waste product from a thermochemical process where wet biomass is converted into biocrude oil. This nutrient-rich wastewater may be repurposed to benefit society by assisting crop growth after adequate treatment to increase inorganic nitrogen, especially NO3 -. This study aims to increase HTL-AP inorganic nitrogen, specifically NH3/NH4 + and NO3 -, through fungal remediation for further use in hydroponic systems. Trametes versicolor, a white-rot fungus known for degrading a range of organic pollutants, was used to treat a diluted (5 %) HTL-AP for 9 days. No fungal growth was observed, but T. versicolor activity was suspected by laccase activity throughout cultivation time. NO3 --N and NH3/NH4 +-N increased by 17 and 8 times after three days of fungal treatment, which was chosen as the appropriate time for HTL-AP fungal treatment as it resulted in the highest concentration of NO3 --N. The addition of nitrifying bacteria to the fungal treatment resulted in a twofold increase in NO3 --N concentration compared to the fungal treatment alone, indicating an enhancement in treatment efficacy. COD decreased by 51.33 % after 24 h, which may be related to the fungus' capacity to reduce the concentration of organics in the wastewater; nonetheless, COD increased in the following days, which may be related to the release of fungal byproducts. T. versicolor shows promise as a potential candidate for increasing inorganic nitrogen in HTL-AP. However, future studies should primarily address HTL-AP toxicity, reducing NH3/NH4 +-N while increasing NO3 --N, and hydroponics crop production after fungal treatment.

Patient Satisfaction and Healthcare Utilization with the Transition to Virtual Care in a Multidisciplinary Bariatric Program.

BACKGROUND: The COVID-19 pandemic saw an acceleration in virtual-visits (VV) for healthcare delivery. However, the impact of virtual care in metabolic/bariatric surgery (MBS) programs is not well described. METHODS: Appointment data from three time-points: pre-pandemic (1/1/19-3/15/20, n = 19,290), pandemic (3/16/20-10/31/21, n = 29,459) and current-state (11/1/21-12/31/2022, n = 24,270) was retrieved in our multi-hospital ambulatory MBS program. Appointments were grouped by health care provider (HCP) (MD, dietician, and psychologist) and type (VV and in-person). Surveys assessing patient satisfaction were distributed electronically. All pre-op and post-op appointment data was analyzed for the time-points above. Appointment completion rates and patient reported preferences were described. RESULTS: Our data showed an increase in scheduled VV from 0.5% for all HCP visits to 81% during the pandemic and a current VV visit of 77%. The number of completed VV increased for all HCPs, most prominently for dieticians. Parallel to this, the percentage of no-show visits also improved for all HCP, with MDs having the lowest no-show rate currently. Survey data revealed 89% of patients experience added benefits with VV and > 90% reported their VV experience as very good. VV were preferred over in-person visits for psychologists and dietitians (> 61%), but the majority preferred to see MDs in-person (70%). CONCLUSIONS: Our findings reveal significant changes in healthcare utilization trends since the transition to virtual care. While overall satisfaction with virtual care is high, most patients prefer in-person visits with MDs. Thus, multi-disciplinary MBS care can be performed effectively using a hybrid model to ensure efficient distribution of resources.

Saturated buffer design flow and performance in Illinois.

There are few peer-reviewed studies documenting saturated buffer annual nitrate (NO3 ) removal or that have assessed the federal practice standard design criteria. Drainage flow, NO3 , and dissolved reactive phosphorus (DRP) were monitored at three saturated buffers in Illinois, USA, for a combined 10 site-years. Nitrate loss reduction averaged 48 ± 19% with removals of 3.5-25.2 kg NO3 -N ha-1 annually. Median DRP concentrations at all sampling locations were at the analytical detection limit of 0.01 mg L-1 . The current design paradigm (i.e., USDA practice standard) prescribes there should be no flow bypassing the saturated buffer at flow rates that are ≤5% of the peak drainage system flow rate. The drainage coefficient-based and Manning's equation-based peak flow estimates were higher and lower, respectively, than the observed annual peaks in all years. This illustrated inherent uncertainty introduced early in the design process, which can be further compounded by dynamic in-buffer hydrology. The percentage of the observed peak flow rate at which bypass initiated ranged across an order of magnitude between sites (4.4-8.1% of peak flow rate at one site and 42-49% of peak at another) despite the buffers providing relatively similar NO3 removal. Bypass at one site (SB2) was related to the concept of "antecedent buffer capacity filled," which was defined as the 5-d average water depth in the middle control structure chamber expressed as a relative percentage of the bypass stop log height. This design flow analysis serves as a call to further evaluate predictive relationships and design models for edge-of-field practices.

Core Ideas Three saturated buffers in Illinois provided an ≈50% annual reduction in NO3 load. Observed peak flow rates differed from estimation methods used for design purposes. Two sites had relatively similar nitrate removals but different bypass trends. "Antecedent buffer capacity filled" was the water depth in the middle chamber as a percent of stop log height.

Assessment of clogging of permeable pavements by measuring change in permeability.

Permeable pavements are a common solution for stormwater management. Porous areas in the pavements allow water to percolate into the subsurface layers, reducing surface runoff. However, it is common for substances to clog the voids, decreasing the porous area and permeability of the pavement system. This study examined the change in permeability over time at a site with two permeable pavement systems, the JW Eco-technology (JW) and pervious concrete (PC). Square frames SF-4 and SF-9 were used to perform falling-head and constant-head permeability tests, respectively. Results show that JW had a similar permeability across the test locations, 6.27-7.64 cm/s when using SF-4, and 0.95-1.00 cm/s when using SF-9. While the permeability at the center locations of PC showed no significant loss of permeability, there was a significant reduction of permeability on the corner and edge areas, where permeability ranged 0.28-1.73 cm/s using SF-4 and 0.14-0.36 cm/s using SF-9, suggesting the occurrence of clogging over time at corner locations. Furthermore, the measured values highlighted the measurement variability in permeability between the falling-head based method and the constant-head method, with measurements from SF-4 being approximately 6.2-7.6 and 2.0-5.7 times higher than those from SF-9 on JW and PC, respectively. In addition, as no current literature quantifies the relationship between permeability and extent of clogging for the JW Eco-technology pavement, evaluation of the proportionate change in permeability with respect to voids, or individual aqueducts, of JW pavement were investigated. While not a 1:1 linear relationship, data indicate that the permeability increased with an increase in non-blocked aqueducts. The JW pavement maintained more than 50% of its capacity when half of the aqueducts were fully blocked. Even when only one aqueduct was clear from clogging, the system had 36% (SF-4) and 19% (SF-9) of maximum permeable capacity.

A quantitative understanding of the role of co-composted biochar in plant growth using meta-analysis.

The combined use of biochar and compost as a soil amendment presents benefits to crops and nutrient cycling. Although there are literature reviews regarding biochar and biochar-compost mixtures, a quantitative literature review on the role of co-composted biochar (hereby called COMBI) in plant productivity is currently missing. The goal of this review paper is to find evidence-based measures of the effects of application rates, soil pH, plant types, biochar feedstock, and compost materials, on plant productivity. Plant productivity covers a variety of measurements but mostly refers to grain yield and above-ground biomass. Response ratio was selected as the effect size. Funnel plot showed that the studies were reasonably symmetrically distributed around the mean effect size. Results showed that application rates of <20 t/ha and >30 t/ha significantly increased plant productivity by 48.3 and 15.7%, respectively, while no significant yield increases were found for the application rates between 20 and 30 t/ha. When data was grouped based on the soil pH, the greatest increase in plant productivity was found to be at acidic soil pH values (pH 4-5), which was expected because the liming effect of biochar is often reported as one of the main mechanisms behind the increased crop yields. When different plant species were compared, cereal grasses grown with COMBI yielded significantly higher grain yields (39.7%). Rice husk biochar yielded the highest increase in productivity but this result was based on only one study. The second highest increase was obtained with wood-based biochars (29.4%) based on ten studies. The effect sizes found with our meta-analyses are based on 14 research works worldwide and represent the most updated information regarding the effects of COMBI on plant production. As more data on COMBI become available, data analyses can be updated to make more robust comparisons.

There's a frog in my salad! A review of online media coverage for wild vertebrates found in prepackaged produce in the United States.

Prepackaged leafy green vegetables represent one of the fastest growing segments of the fresh-produce industry in the United States. Several steps in the production process have been mechanized to meet the downstream demand for prebagged lettuces. The growth in this market, however, has come with drawbacks, and chief among them are consumers finding wild animals in prepackaged crops. These incidents may signal an overburdened produce supply chain, but we currently lack the information needed to determine if this is a food-safety problem or food-quality concern. Here, we address this gap by reviewing online media coverage of wild vertebrates found in prepackaged produce items by customers in the United States. We discovered 40 independent incidents since 2003 with 95% having occurred during 2008-2018, suggesting that the frequency of incidents may have increased during the last decade. The minority of incidents included wild animals found in organic produce (27.5%), whereas the majority involved conventionally grown crops (72.5%). Most incidents involved amphibians (52.5%) and reptiles (22.5%), while fewer contained mammals (17.5%) and birds (7.5%). Frogs and toads made up all of the amphibian-related incidents, with more than 60% comprising small-bodied treefrogs found in various types of fresh leafy greens. At least seven incidents involved Pacific Treefrogs (Hyliola regilla) and three comprised Green Anoles (Anolis carolinensis). One lizard and nine frogs were found alive, and at least two frogs were released into non-native areas. This is the first review quantifying incidents of vertebrates found by customers in prepackaged produce, yet it remains unclear whether these occurrences indicate a food-safety crisis or a complaint against food quality. Nevertheless, wild animals can spread diseases to humans via contaminated produce, therefore we contend that industry professionals can reduce the potential health risk to their consumers and negative economic consequences to themselves through increased attention to this matter.

Resting-State Brain Connectivity Predicts Weight Loss and Cognitive Control of Eating Behavior After Vertical Sleeve Gastrectomy.

OBJECTIVE: The effects of sleeve gastrectomy (SG) on functional connectivity (FC) and associations with weight loss and eating-related cognitive control were investigated. METHODS: In a longitudinal study, 14 SG patients (13 female; 42.1 presurgery BMI) completed study visits 1 month pre surgery and 12 months post surgery. Patients completed the Dutch Eating Behavior Questionnaire and resting-state functional magnetic resonance imaging scanning to measure FC. Data were analyzed using a seed-to-voxel approach in the CONN Toolbox to investigate pre-/postsurgery changes (n = 12) and to conduct predictive analysis (n = 14). RESULTS: Seed-to-voxel analysis revealed changes in magnitude (decreases) and directionality (positively correlated to anticorrelated) of FC pre to post surgery within and between default mode network, salience network, and frontoparietal network nodes [Family-Wise Error (FWE) corrected at P < 0.05]. Baseline FC of the nucleus accumbens (with insula) and hypothalamus (with precentral gyrus) predicted 12-month post-SG % total weight loss (FWE-P < 0.05). Baseline FC of the hippocampus, frontoparietal network, and default mode network nodes predicted improvement in cognitive control of eating behavior 12 months after SG (FWE-P < 0.05). CONCLUSIONS: Our findings demonstrate changes in FC magnitude and directionality post versus pre surgery within and between resting-state networks and frontal, paralimbic, and visual areas in SG patients. Baseline FC predicted weight loss and changes in cognitive control of food intake behavior at 12 months. These could serve as predictive biomarkers for bariatric surgery.

Chronic pain assessment: a seven-factor model.

BACKGROUND: There are many measures assessing related dimensions of the chronic pain experience (eg, pain severity, pain coping, depression, activity level), but the relationships among them have not been systematically established. OBJECTIVE: The present study set out to determine the core dimensions requiring assessment in individuals with chronic pain. METHODS: Individuals with chronic pain (n=126) completed the Beck Anxiety Inventory, Beck Depression Inventory, Beck Hopelessness Scale, Chronic Pain Coping Index, Multidimensional Pain Inventory, Pain Catastrophizing Scale, McGill Pain Questionnaire--Short Form, Pain Disability Index and the Tampa Scale of Kinesiophobia. RESULTS: Before an exploratory factor analysis (EFA) of the nine chronic pain measures, EFAs were conducted on each of the individual measures, and the derived factors (subscales) from each measure were submitted together for a single EFA. A seven-factor model best fit the data, representing the core factors of pain and disability, pain description, affective distress, support, positive coping strategies, negative coping strategies and activity. CONCLUSIONS: Seven meaningful dimensions of the pain experience were reliably and systematically extracted. Implications and future directions for this work are discussed.

EEG-based lapse detection with high temporal resolution.

A warning system capable of reliably detecting lapses in responsiveness (lapses) has the potential to prevent many fatal accidents. We have developed a system capable of detecting lapses in real-time with second-scale temporal resolution. Data was from 15 subjects performing a visuomotor tracking task for two 1-hour sessions with concurrent electroencephalogram (EEG) and facial video recordings. The detector uses a neural network with normalized EEG log-power spectrum inputs from two bipolar EEG derivations, though we also considered a multichannel detector. Lapses, identified using a combination of video rating and tracking behavior, were used to train our detector. We compared detectors employing tapped delay-line linear perceptron, tapped delay-line multilayer perceptron (TDL-MLP), and long short-term memory (LSTM) recurrent neural networks operating continuously at 1 Hz. Using estimates of EEG log-power spectra from up to 4 s prior to a lapse improved detection compared with only using the most recent estimate. We report the first application of a LSTM to an EEG analysis problem. LSTM performance was equivalent to the best TDL-MLP network but did not require an input buffer. Overall performance was satisfactory with area under the curve from receiver operating characteristic analysis of 0.84 +/- 0.02 (mean +/- SE) and area under the precision-recall curve of 0.41 +/- 0.08.

WiseEye: Next Generation Expandable and Programmable Camera Trap Platform for Wildlife Research.

The widespread availability of relatively cheap, reliable and easy to use digital camera traps has led to their extensive use for wildlife research, monitoring and public outreach. Users of these units are, however, often frustrated by the limited options for controlling camera functions, the generation of large numbers of images, and the lack of flexibility to suit different research environments and questions. We describe the development of a user-customisable open source camera trap platform named 'WiseEye', designed to provide flexible camera trap technology for wildlife researchers. The novel platform is based on a Raspberry Pi single-board computer and compatible peripherals that allow the user to control its functions and performance. We introduce the concept of confirmatory sensing, in which the Passive Infrared triggering is confirmed through other modalities (i.e. radar, pixel change) to reduce the occurrence of false positives images. This concept, together with user-definable metadata, aided identification of spurious images and greatly reduced post-collection processing time. When tested against a commercial camera trap, WiseEye was found to reduce the incidence of false positive images and false negatives across a range of test conditions. WiseEye represents a step-change in camera trap functionality, greatly increasing the value of this technology for wildlife research and conservation management.

Common encoding of novel dynamic loads applied to the hand and arm.

In manual action, the relationship between a given motor command and the ensuing movement depends on the dynamics of both the arm and hand-held objects. Skilled performance relies on the brain learning both these dynamics, and previous studies have examined how people adapt to novel loads applied to either the hand or the arm. In this study, we ask whether these different kinds of load are represented independently as a result of changes in cutaneous feedback and hand-arm coordination. We used a robotic apparatus that could either apply forces to an object held in the subject's hand or directly to the segments of the arm. We tested whether subjects could retain learning of a force field applied to the hand after subsequently experiencing the opposing field applied to the arm (or vice versa), or whether retrograde interference would be observed. In separate experiments, we used force fields and torque fields that were linearly related to either hand or joint velocities, respectively. Our finding of complete interference between opposing fields suggests that loads applied to the arm and hand are not represented independently by the sensorimotor system. This interference occurred despite markedly different cutaneous inputs that were directly related to the movement task. This result suggests that the brain represents dynamics independently of these sensory inputs. In addition, we found that the rate at which subjects adapted to a given force field, specified either in hand or joint coordinates, was independent of whether the forces were applied to the hand or arm segments.

Motor learning and prediction in a variable environment.

Traditional studies of motor learning and prediction have focused on how subjects perform a single task. Recent advances have been made in our understanding of motor learning and prediction by investigating the way we learn variable tasks, which change either predictably or unpredictably over time. Similarly, studies have examined how variability in our own movements affects motor learning.

Improving hyperglycemia management in the intensive care unit: preliminary report of a nurse-driven quality improvement project using a redesigned insulin infusion algorithm.

PURPOSE: The purpose of this study was to assess the feasibility of a nurse-driven effort to improve hyperglycemia management in the intensive care unit (ICU) setting. METHODS: The setting was the ICU of a large urban hospital. The program was composed of 3 components: nurses as leaders, a clinical pathway to identify patients in need of hyperglycemia therapy, and implementation of a redesigned insulin infusion algorithm (the Columnar Insulin Dosing Chart). Time to reach a target glucose range of 80 to 110 mg/dL (4.4-6.1 mmol/L) was evaluated. RESULTS: One hundred sixteen ICU nurses were trained in the project. The Columnar Insulin Dosing Chart was applied to 20 patients. The average time required to reach the target blood glucose range was 12.8 hours. Below-target blood glucose levels were 6.9% of all blood glucose levels recorded, but only 0.9% were below 60 mg/dL (3.3 mmol/L). There was no sustained hypoglycemia, and no persistent clinical findings attributable to hypoglycemia were noted. Barriers to implementing the project included an increased nursing workload, the need for more finger-stick blood glucose monitors, and the need to acquire new finger-lancing devices that allowed for shallower skin puncture and increased patient comfort. CONCLUSIONS: Tighter glycemic control goals can be attained in a busy ICU by a nurse-led team using a pathway for identifying and treating hyperglycemia, clear decision support tools, and adequate nurse education. The novel chart-based insulin infusion algorithm chosen as the standard for this pilot was an effective tool for reducing the blood glucose to target range with no clinically significant hypoglycemia.

Glucommander: a computer-directed intravenous insulin system shown to be safe, simple, and effective in 120,618 h of operation.

OBJECTIVE: Intravenous insulin is now the recommended method of diabetes management in critically ill persons in the hospital. The published methods for administering the insulin are complex and are usually limited to intensive care units with a low patient-to-nurse ratio. RESEARCH DESIGN AND METHODS: A computer-directed algorithm for advice on the delivery of intravenous insulin that is flexible in blood glucose timing and advises insulin dosing in a graduated manner has been developed. This software program, known as the Glucommander, has been used extensively by our group. The data were analyzed for this study. RESULTS: The data from 5,080 intravenous insulin runs over 120,683 h show that blood glucose levels can be safely stabilized in a target range without significant hypoglycemia by nonspecialized nurses working on any unit of a general hospital. The mean glucose level reached <150 mg/dl in 3 h. Only 0.6% of all glucose values were <50 mg/dl. The prevalence of hypoglycemia <40 mg/dl was 2.6% of all runs. No hypoglycemia was severe. CONCLUSIONS: This computer-directed algorithm is a simple, safe, effective, and robust method for maintaining glycemic control. It has been extensively studied and is applicable in a wide variety of conditions. In contrast to other published intravenous insulin protocols, which have been limited to intensive care units, Glucommander can be used in all units of any hospital.

The walk-in clinic model improves access to psychiatry in primary care.

OBJECTIVE: Missed appointments decrease clinic capacity and negatively affect health outcomes. The objective of this study was to increase the proportion of filled initial psychiatry appointments in an urban, hospital-based primary care practice. METHODS: Patients were identified as having a high or low risk of missing their initial psychiatry appointments based on prior missed medical appointments. High-risk patients were referred to a walk-in clinic instead of a scheduled appointment. The primary outcome was ratio of filled appointments to booked appointments. We used a statistical process control chart (p chart) to measure improvement. Secondary outcomes were percentages of patients from historically underserved groups who received an initial psychiatry evaluation before and after the intervention. RESULTS: The average ratio of filled to booked initial appointments increased from 59% to 77% after the intervention, and the p chart confirmed that this change represented special cause variation. No statistically significant demographic differences between the patients who received psychiatric evaluations before and after the intervention were found. CONCLUSIONS: Missed initial psychiatry appointments can be accurately predicted by prior missed medical appointments. A referral-based walk-in clinic is feasible and does not reduce access to care for historically underserved patient groups.

Effects of formulation on transport of pyrethroids in residential settings.

Washoff of 17 pyrethroid products resulting from a 1-h, 25.4-mm rainfall occurring 24 h after application was measured in indoor studies with concrete slabs. These products included different pyrethroid active ingredients and a range of formulation types. Based on this replicated study, 5 product pairs with contrasting washoff behaviors were chosen for an outdoor study using 6 full-scale house fronts in central California. Products in 4 of these pairs were applied once to different rectangular areas on the driveway (1 product in each pair to 3 house lots and the other to the remaining 3 house lots). The products in the fifth pair were applied 3 times at 2-mo intervals to vertical stucco walls above the driveway. All house lots received natural and simulated rainfall over 7 mo. Indoor studies showed differences up to 170-fold between paired products, whereas the maximum difference between paired products in the field was only 5-fold. In the pair applied to the wall, 1 product had 91 times the washoff of the other in the indoor study, whereas in the field the same product had 15% lower washoff. These results show that, although the formulation may influence washoff under actual use conditions, its influence is complex and not always as predicted by indoor experiments. Because the formulation also affects insect control, washoff research needs to be conducted together with efficacy testing.

Widespread access to predictive models in the motor system: a short review.

Recent behavioural and computational studies suggest that access to internal predictive models of arm and object dynamics is widespread in the sensorimotor system. Several systems, including those responsible for oculomotor and skeletomotor control, perceptual processing, postural control and mental imagery, are able to access predictions of the motion of the arm. A capacity to make and use predictions of object dynamics is similarly widespread. Here, we review recent studies looking at the predictive capacity of the central nervous system which reveal pervasive access to forward models of the environment.