Policy Interventions to Enhance Medical Care for People With Obesity in the United States-Challenges, Opportunities, and Future Directions.

Policy Points Health policymakers have insufficiently addressed care for people with obesity (body mass index ≥ 30 kg/m2) in the United States. Current federal policies targeting obesity medications reflect this unfortunate reality. We argue for a novel policy framework to increase access to effective obesity therapeutics and care, recognizing that, though prevention is critical, the epidemic proportions of obesity in the United States warrant immediate interventions to augment care. Reducing barriers to and improving the quality of existing anti-obesity medications, intensive behavioral therapy, weight management nutrition and dietary counseling, and bariatric surgery are critical. Moreover, to ensure continuity of care and patient-clinician trust, combating physician and broader weight stigma must represent a central component of any viable obesity care agenda.

To err is human- to understand error-processing is divine: Contributions of working memory and anxiety to error-related brain and pupil responses.

Both anxiety and working memory capacity appear to predict increased (more negative) error-related negativity (ERN) amplitudes, despite being inversely related to one another. Until the interactive effects of these variables on the ERN are clarified, there may be challenges posed to our ability to use the ERN as an endophenotype for anxiety, as some have suggested. The compensatory error monitoring hypothesis suggests that high trait-anxiety individuals have larger ERN amplitudes because they must employ extra, compensatory efforts to override the working memory demands of their anxiety. Yet, to our knowledge, no ERN study has employed direct manipulation of working memory demands in conjunction with direct manipulations of induced (state) anxiety. Furthermore, little is known about how these manipulations affect other measures of error processing, such as the error-related pupil dilation response and post-error behavioral adjustments. Therefore, we manipulate working memory load and anxiety in a 2 × 2 within-subjects design to examine the interactive effects of working memory load and anxiety on ERN amplitude, error-related pupil dilation response amplitude, and post-error behavior. There were no effects of our manipulations on ERN amplitude, suggesting a strong interpretation of compensatory error-processing theory. However, our worry manipulation affected post-error behavior, such that worry caused a reduction in post-error accuracy. Additionally, our working memory manipulation affected error-related PDR magnitude and the amplitude of the error-related positivity (Pe), such that increased working memory load decreased the amplitude of these responses. Implications of these results within the context of the compensatory error processing framework are discussed.

Suture button compared with K-wire fixation for maintenance of posttrapeziectomy space height in a cadaver model of lateral pinch.

PURPOSE: Hematoma distraction arthroplasty has regained popularity as a treatment for thumb carpometacarpal arthritis with reports of satisfactory results. Our goal was to investigate the use of a suture button device to maintain the posttrapeziectomy space height of the thumb metacarpal. Our hypothesis is that a suture button that suspends the thumb metacarpal from the second metacarpal, when applied to the hematoma distraction arthroplasty technique, would provide subsidence resistance comparable to traditional K-wire fixation. METHODS: Ten fresh frozen matched pairs of human cadaveric arms were used. After open trapeziectomy, suspension of the thumb metacarpal was performed with either a 1.4-mm (0.045-inch) K-wire advanced through the base of the thumb metacarpal into the second metacarpal shaft or a suture button device that suspended the thumb metacarpal from the second metacarpal shaft. Cyclic pinch was simulated by using a lateral pinch model previously described and validated. Lateral pinch is simulated by loading the extensor pollicis longus, adductor pollicis, abductor pollicis brevis, and flexor pollicis longus in a 1:5:6:10 ratio. Dynamic pinch is achieved with cyclic unloading of the abductor pollicis brevis, adductor pollicis, and flexor pollicis longus tendons. Measurements were made of the height of excised trapeziums, the distance from the metacarpal base to the scaphoid after trapeziectomy (trapeziectomy space height) at time zero, both loaded and unloaded, and at sequential loading cycles of 1,000, 2,000, 3,000, 4,000, 5,000, and 10,000 cycles. RESULTS: Student t-test evaluation showed no significant differences between the groups in initial trapeziectomy space height (p = .10), postfixation trapeziectomy space height (p = .10), or loss of trapeziectomy space height between precycling and after 10,000 cycles (p = .80). CONCLUSIONS: Suture button fixation maintains similar posttrapeziectomy space height and prevents subsidence of the thumb metacarpal when compared with K-wire fixation in this model. This technique may allow for earlier range of motion after the hematoma distraction arthroplasty.