Perceived barriers and facilitators to healthy eating and physical activity in endoscopic bariatric patients: a qualitative study.

PURPOSE: To explore the perceived barriers and facilitators to healthy eating and physical activity in individuals opting for endoscopic bariatric procedures. METHODS: A total of 55 participants were recruited from a metropolitan bariatric clinic in Australia. Participants were interviewed at one of two stages of treatment: pre-procedure (n = 34) or 5-6 months post-procedure (n = 18). Interviews were transcribed and analyzed using content analysis. RESULTS: Five themes emerged from analysis of participant responses in both groups including lifestyle, psychological, physiological, social, and eating behaviors. Each theme consisted of subthemes which were either perceived barriers, or facilitators, to healthy eating and physical activity. Perceived barriers consisted of factors such as time constraints, low motivation, unhealthy habits and portion control, low priority of personal health, emotional difficulties, and pain/mobility issues. Facilitators included subthemes such as planning/organization, high motivation, seeing results, improved self-esteem, increased energy, improved mobility, and changing mindset about portions. CONCLUSION: The results highlight the importance of delivering individualized and targeted treatment plans for individuals opting for bariatric procedures. LEVEL OF EVIDENCE: Level III: Evidence obtained from cohort or case-control analytic studies.

A map of transcriptional heterogeneity and regulatory variation in human microglia.

Microglia, the tissue-resident macrophages of the central nervous system (CNS), play critical roles in immune defense, development and homeostasis. However, isolating microglia from humans in large numbers is challenging. Here, we profiled gene expression variation in primary human microglia isolated from 141 patients undergoing neurosurgery. Using single-cell and bulk RNA sequencing, we identify how age, sex and clinical pathology influence microglia gene expression and which genetic variants have microglia-specific functions using expression quantitative trait loci (eQTL) mapping. We follow up one of our findings using a human induced pluripotent stem cell-based macrophage model to fine-map a candidate causal variant for Alzheimer's disease at the BIN1 locus. Our study provides a population-scale transcriptional map of a critically important cell for human CNS development and disease.

Correction to: Niacin-mediated rejuvenation of macrophage/microglia enhances remyelination of the aging central nervous system.

The article Niacin­mediated rejuvenation of macrophage/microglia enhances remyelination of the aging central nervous system, written by Khalil S. Rawji, Adam M.H. Young, Tanay Ghosh, Nathan J. Michaels, Reza Mirzaei, Janson Kappen, Kathleen L. Kolehmainen, Nima Alaeiilkhchi, Brian Lozinski, Manoj K. Mishra, Annie Pu, Weiwen Tang, Salma Zein, Deepak K. Kaushik, Michael B. Keough, Jason R. Plemel, Fiona Calvert, Andrew J. Knights, Daniel J. Gaffney, Wolfram Tetzlaff, Robin J. M. Franklin and V. Wee Yong, was originally published electronically on the publisher's internet.

Niacin-mediated rejuvenation of macrophage/microglia enhances remyelination of the aging central nervous system.

Remyelination following CNS demyelination restores rapid signal propagation and protects axons; however, its efficiency declines with increasing age. Both intrinsic changes in the oligodendrocyte progenitor cell population and extrinsic factors in the lesion microenvironment of older subjects contribute to this decline. Microglia and monocyte-derived macrophages are critical for successful remyelination, releasing growth factors and clearing inhibitory myelin debris. Several studies have implicated delayed recruitment of macrophages/microglia into lesions as a key contributor to the decline in remyelination observed in older subjects. Here we show that the decreased expression of the scavenger receptor CD36 of aging mouse microglia and human microglia in culture underlies their reduced phagocytic activity. Overexpression of CD36 in cultured microglia rescues the deficit in phagocytosis of myelin debris. By screening for clinically approved agents that stimulate macrophages/microglia, we have found that niacin (vitamin B3) upregulates CD36 expression and enhances myelin phagocytosis by microglia in culture. This increase in myelin phagocytosis is mediated through the niacin receptor (hydroxycarboxylic acid receptor 2). Genetic fate mapping and multiphoton live imaging show that systemic treatment of 9-12-month-old demyelinated mice with therapeutically relevant doses of niacin promotes myelin debris clearance in lesions by both peripherally derived macrophages and microglia. This is accompanied by enhancement of oligodendrocyte progenitor cell numbers and by improved remyelination in the treated mice. Niacin represents a safe and translationally amenable regenerative therapy for chronic demyelinating diseases such as multiple sclerosis.

Supervisee perceptions of the use of metacommunication in the supervisory relationship.

Objective: This study examined the use of metacommunication in supervision from supervisees' perspectives. Method: A total of 129 supervisees completed the Metacommunication in Supervision Questionnaire-MSQ, a measure devised for the purpose of this study to explore the frequency and willingness to use various forms of metacommunication in clinical supervision. Measures of the nature of the supervisory relationship (also from the supervisee's perspective) were taken to explore whether a relationship exists between the nature of supervision and supervisees' perspectives on the use of metacommunication. Results: There was general concordance between supervisee ratings of their own willingness and their perception of their supervisor's willingness to use various forms of metacommunication in supervision. There were significant differences in the reported frequency with which the different types of metacommunication are actually used. A factor analysis elicited a two-factor structure underlying the MSQ and significant correlations with measures of the nature of the supervision relationship were observed. It appears that metacommunication around difficult or uncomfortable feelings in the supervisory relationship occurs less often than other components of metacommunication. Conclusion: Future research needs to further validate the MSQ and assess whether the frequency of metacommunication in the supervisory relationship is related to metacommunication in supervisees' psychotherapy with clients.

Improvements in psychologists' metacommunication self-efficacy, willingness, and skill following online training and a supervision exercise.

OBJECTIVE(S): Psychologists' experiences of an online training tool in metacommunication as well as an in-supervisory metacommunication exercise were examined. METHOD: A total of 101 participants completed a training tool in metacommunication and changes in self-efficacy (SE) to use metacommunication with clients, the proportion of metacommunication used in vignette-responses, and their willingness to use metacommunication in supervision were assessed pre- and posttraining and at 6-week follow-up. A total of 48 participants elected to undertake the in-supervision exercise. RESULTS: Participants reported significantly higher willingness and self-efficacy after completing the online training. They also showed a higher proportion of metacommunicative statements in their posttraining vignette responses compared with pretraining. The increase in willingness was retained at 6-week follow-up. There was an increase in self-efficacy from pre- to postonline-training, and this increased at follow-up. CONCLUSIONS: This opens the door to better developing metacommunication skills in supervisees through both online training and the metacommunication supervisory exercise. Areas for continued research are outlined.

Group schema therapy for eating disorders: study protocol.

BACKGROUND: The treatment of eating disorders is a difficult endeavor, with only a relatively small proportion of clients responding to and completing standard cognitive behavioural therapy (CBT). Given the prevalence of co-morbidity and complex personality traits in this population, Schema Therapy has been identified as a potentially viable treatment option. A case series of Group Schema Therapy for Eating Disorders (ST-E-g) yielded positive findings and the study protocol outlined in this article aims to extend upon these preliminary findings to evaluate group Schema Therapy for eating disorders in a larger sample (n = 40). METHODS/DESIGN: Participants undergo a two-hour assessment where they complete a number of standard questionnaires and their diagnostic status is ascertained using the Eating Disorder Examination. Participants then commence treatment, which consists of 25 weekly group sessions lasting for 1.5 h and four individual sessions. Each group consists of five to eight participants and is facilitated by two therapists, at least one of who is a registered psychologist trained on schema therapy. The primary outcome in this study is eating disorder symptom severity. Secondary outcomes include: cognitive schemas, self-objectification, general quality of life, self-compassion, schema mode presentations, and Personality Disorder features. Participants complete psychological measures and questionnaires at pre, post, six-month and 1-year follow-up. DISCUSSION: This study will expand upon preliminary research into the efficacy of group Schema Therapy for individuals with eating disorders. If group Schema Therapy is shown to reduce eating disorder symptoms, it will hold considerable promise as an intervention option for a group of disorders that is typically difficult to treat. TRIAL REGISTRATION: ACTRN12615001323516. Registered: 2/12/2015 (retrospectively registered, still recruiting).

Lyplal1 is dispensable for normal fat deposition in mice.

Genome-wide association studies (GWAS) have detected association between variants in or near the Lysophospholipase-like 1 (LYPLAL1) locus and metabolic traits, including central obesity, fatty liver and waist-to-hip ratio. LYPLAL1 is also known to be upregulated in the adipose tissue of obese patients. However, the physiological role of LYPLAL1 is not understood. To investigate the function of Lyplal1 in vivo we investigated the phenotype of the Lyplal1tm1a(KOMP)Wtsi homozygous mouse. Body composition was unaltered in Lyplal1 knockout mice as assessed by dual-energy X-ray absorptiometry (DEXA) scanning, both on normal chow and on a high-fat diet. Adipose tissue distribution between visceral and subcutaneous fat depots was unaltered, with no change in adipocyte cell size. The response to both insulin and glucose dosing was normal in Lyplal1tm1a(KOMP)Wtsi homozygous mice, with normal fasting blood glucose concentrations. RNAseq analysis of liver, muscle and adipose tissue confirmed that Lyplal1 expression was ablated with minimal additional changes in gene expression. These results suggest that Lyplal1 is dispensable for normal mouse metabolic physiology and that despite having been maintained through evolution Lyplal1 is not an essential gene, suggesting possible functional redundancy. Further studies will be required to clarify its physiological role.