Feasibility of a Wearable-Based Physical Activity Goal-Setting Intervention Among Individuals With Anterior Cruciate Ligament Reconstruction.

CONTEXT: Individuals with a history of anterior cruciate ligament reconstruction (ACLR) demonstrate persistent reductions in physical activity (PA) volume that are not being addressed during rehabilitation. Currently, it is challenging for clinicians to prescribe exercise interventions that extend beyond in-person rehabilitative care in a manner that is responsive and acceptable to patients. OBJECTIVE: To investigate the feasibility of using a novel, technology-driven, personalized goal-setting intervention over a 2-month period among young individuals with a history of primary unilateral ACLR. DESIGN: Single-blinded feasibility study. SETTING: University community. PATIENTS OR OTHER PARTICIPANTS: Ten women and 2 men (age = 22.0 ± 3.0 years, time since surgery = 56.0 ± 36.3 months) with a history of primary unilateral ACLR. INTERVENTION(S): All participants completed a 28-day PA observation period immediately followed by a 28-day individualized PA goal-setting intervention period delivered via a commercially available PA monitor. MAIN OUTCOME MEASURE(S): Primary feasibility outcomes were days of PA monitor wear compliance and days of goal achievement during the intervention period. Participants also completed the Knee Osteoarthritis Outcome Score (KOOS) at study enrollment and after the intervention period, and the individual change in the KOOS Quality of Life subscale was compared with the minimal detectable change (7.2 points). RESULTS: Average PA monitor wear compliance was 95.5% ± 7.3% during the observation period and 97.7% ± 2.9% during the intervention period. Median goal achievement was 31.5% ± 6.8% during the intervention period. Five participants demonstrated meaningful improvements in the KOOS Quality of Life subscale during the study period. CONCLUSIONS: Individualized goal setting via mobile technology appears to be a feasible approach to PA promotion. However, based on the low rate of daily goal attainment during the intervention period, continued refinement of this intervention aproach would be beneficial before broad clinical implementation.

The complementary and divergent roles of uncoupling proteins 1 and 3 in thermoregulation.

KEY POINTS: Both uncoupling protein 1 (UCP1) and UCP3 are important for mammalian thermoregulation. UCP1 and UCP3 in brown adipose tissue mediate early and late phases of sympathomimetic thermogenesis, respectively. Lipopolysaccharide thermogenesis requires skeletal muscle UCP3 but not UCP1. Acute noradrenaline-induced hyperthermia requires UCP1 but not UCP3. Loss of both UCP1 and UCP3 accelerate the loss of body temperature compared to UCP1KO alone during acute cold exposure. ABSTRACT: Uncoupling protein 1 (UCP1) is the established mediator of brown adipose tissue-dependent thermogenesis. In contrast, the role of UCP3, expressed in both skeletal muscle and brown adipose tissue, in thermoregulatory physiology is less well understood. Here, we show that mice lacking UCP3 (UCP3KO) have impaired sympathomimetic (methamphetamine) and completely abrogated lipopolysaccharide (LPS) thermogenesis, but a normal response to noradrenaline. By comparison, UCP1 knockout (UCP1KO) mice exhibit blunted methamphetamine and fully inhibited noradrenaline thermogenesis, but an increased febrile response to LPS. We further establish that mice lacking both UCP1 and 3 (UCPDK) fail to show methamphetamine-induced hyperthermia, and have a markedly accelerated loss of body temperature and survival after cold exposure compared to UCP1KO mice. Finally, we show that skeletal muscle-specific human UCP3 expression is able to significantly rescue LPS, but not sympathomimetic thermogenesis blunted in UCP3KO mice. These studies identify UCP3 as an important mediator of physiological thermogenesis and support a renewed focus on targeting UCP3 in metabolic physiology.

Changes in coping, pain, and activity after cognitive-behavioral training: a randomized clinical trial for pediatric sickle cell disease using smartphones.

OBJECTIVES: We examined the outcomes of a cognitive-behavioral therapy (CBT) intervention for pain in pediatric sickle cell disease (SCD) using smartphones as a novel delivery method. MATERIALS AND METHODS: Forty-six children with SCD received CBT coping skills training using a randomized, waitlist control design. The intervention involved a single session of CBT training and home-based practice using smartphones for 8 weeks. Pre-post questionnaires between the randomized groups were used to evaluate changes in active psychological coping and negative thinking using the Coping Strategies Questionnaire. Daily diaries completed by the full sample during the treatment period were used to assess whether CBT skill use was related to reductions in next-day pain intensity and increases in same-day functional activity. RESULTS: The pre-post group comparison suggested that the youth increased active psychological coping attempts with the intervention. Daily diary data indicated that when children used CBT skills on days with higher pain, there were reductions in next-day pain intensity. There was no such association between skill use and functional activity. DISCUSSION: CBT coping skills training supported using smartphones can increase coping and reduce pain intensity for children with SCD; however, additions to the study protocols are recommended in future studies. Advantages and caveats of using smartphones are also discussed.

A tool to determine financial impact of adverse events in health care: healthcare quality calculator.

OBJECTIVES: Hospital leaders lack tools to determine the financial impact of poor patient outcomes and adverse events. To provide health-care leaders with decision support for investments to improve care, we created a tool, the Healthcare Quality Calculator (HQCal), which uses institution-specific financial data to calculate impact of poor patient outcomes or quality improvement on present and future margin. METHODS: Excel and Web-based versions of the HQCal were based on a cohort study framework and created with modular components including major drivers of cost and reimbursement. RESULTS: The Healthcare Quality Calculator (HQCal) compares payment, cost, and profit/loss for patients with and without poor outcomes or quality issues. Cost and payment information for groups with and without quality issues are used by the HQCal to calculate profit or loss. Importantly, institution-specific payment and cost data are used to calculate financial impact and attributable cost associated with poor patient outcomes, adverse events, or quality issues. Because future cost and reimbursement changes can be forecast, the HQCal incorporates a forward-looking component. The flexibility of the HQCal was demonstrated using surgical site infections after abdominal surgery and postoperative surgical airway complications. CONCLUSIONS: The Healthcare Quality Calculator determines financial impact of poor patient outcomes and the benefit of initiatives to improve quality. The calculator can identify quality issues that would provide the largest financial benefit if improved; however, it cannot identify specific interventions. The calculator provides a tool to improve transparency regarding both short- and long-term financial consequences of funding, or failing to fund, initiatives to close gaps in quality or improve patient outcomes.

Caenorhabditis elegans UCP4 protein controls complex II-mediated oxidative phosphorylation through succinate transport.

The novel uncoupling proteins (UCP2-5) are implicated in the mitochondrial control of oxidant production, insulin signaling, and aging. Attempts to understand their functions have been complicated by overlapping expression patterns in most organisms. Caenorhabditis elegans nematodes are unique because they express only one UCP ortholog, ceUCP4 (ucp4). Here, we performed detailed metabolic analyzes in genetically modified nematodes to define the function of the ceUCP4. The knock-out mutant ucp4 (ok195) exhibited sharply decreased mitochondrial succinate-driven (complex II) respiration. However, respiratory coupling and electron transport chain function were normal in ucp4 mitochondria. Surprisingly, isolated ucp4 mitochondria showed markedly decreased succinate uptake. Similarly, ceUCP4 inhibition blocked succinate respiration and import in wild type mitochondria. Genetic and pharmacologic inhibition of complex I function was selectively lethal to ucp4 worms, arguing that ceUCP4-regulated succinate transport is required for optimal complex II function in vivo. Additionally, ceUCP4 deficiency prolonged lifespan in the short-lived mev1 mutant that exhibits complex II-generated oxidant production. These results identify a novel function for ceUCP4 in the regulation of complex II-based metabolism through an unexpected mechanism involving succinate transport.

Conversion of cyanthiwigin U to related cyanthiwigins: total syntheses of cyanthiwigin W and cyanthiwigin Z.

The conversion of cyanthiwigin U to cyanthiwigins W and Z is described.

Total synthesis of (+)-cyanthiwigin U.

A concise total synthesis of the tricyclic terpene cyanthiwigin U has been accomplished in 12 steps and 17% overall yield. The key step of the synthesis is a two-directional tandem metathesis reaction that forms the cyclohepta[e]indene core from a readily available bicyclo[2.2.2]octene.