Tracking physical activity using smart phone apps: assessing the ability of a current app and systematically collecting patient recommendations for future development.

BACKGROUND: Within the United Kingdom's National Health System (NHS), patients suffering from obesity may be provided with bariatric surgery. After receiving surgery many of these patients require further support to continue to lose more weight or to maintain a healthy weight. Remotely monitoring such patients' physical activity and other health-related variables could provide healthworkers with a more 'ecologically valid' picture of these patients' behaviours to then provide more personalised support. The current study assesses the feasibility of two smartphone apps to do so. In addition, the study looks at the barriers and facilitators patients experience to using these apps effectively. METHODS: Participants with a BMI > 35 kg/m2 being considered for and who had previously undergone bariatric surgery were recruited. Participants were asked to install two mobile phone apps. The 'Moves' app automatically tracked participants' physical activity and the 'WLCompanion' app prompted participants to set goals and input other health-related information. Then, to learn about participants' facilitators and barriers to using the apps, some participants were asked to complete a survey informed by the Theoretical Domains Framework. The data were analysed using regressions and descriptive statistics. RESULTS: Of the 494 participants originally enrolled, 274 participants data were included in the analyses about their activity pre- and/or post-bariatric surgery (ages 18-65, M = 44.02, SD ± 11.29). Further analyses were performed on those 36 participants whose activity was tracked both pre- and post-surgery. Participants' activity levels pre- and post-surgery did not differ. In addition, 54 participants' survey responses suggested that the main facilitator to their continued use of the Moves app was its automatic nature, and the main barrier was its battery drain. CONCLUSIONS: The current study tracked physical activity in patients considered for and who had previously undergone bariatric surgery. The results should be interpreted with caution because of the small number of participants whose data meet the inclusion criteria and the barriers participants encountered to using the apps. Future studies should take note of the barriers to develop more user-friendly apps. TRIAL REGISTRATION: ClinicalTrials.gov- NCT01365416 on the 3rd of June 2011.

[Sutured Posterior Chamber IOL Fixation in the Absence of Capsular Support, First Described in 1954]. / Erstbeschreibung einer nahtfixierten Hinterkammerlinse im Jahre 1954.

BACKGROUND: By implanting the first IOL in 1949 Ridley's intention was to replace the opaque crystalline lens with a "lenticulus" exactly the size and the shape of the natural lens in the same physiological location in the posterior chamber. Still not resolved at that time was the fixation of the "pseudophakos" following intracapsular cataract extraction and the centration on the posterior capsule or, respectively, on residues of the anterior capsule following extracapsular cataract surgery. We describe the first attempts in 1954 of fixating a posterior chamber IOL following intracapsular extraction using a suture technique. MATERIAL AND METHODS: Selective literature research via PubMed was undertaken and additional literature retrieved by a manual search was included. RESULTS: The conventional opinion that suture fixation of intraocular lenses was carried out since the 1980s and that Pearce in 1975 and Shearing in 1977 solved this problem by using haptics made of polypropylene is not quite correct: In 1954, by using a thin wire anchored in the IOL material, the British ophthalmologist, T. G. W. Parry, managed the first suture fixation of a Ridley IOL in the posterior chamber. CONCLUSIONS: This remarkable medical historical innovation was however overshadowed by the rapid development of intraocular lenses, from iris-fixated lenses ("collar stud": Epstein 1954, "iris-clip": Binkhorst 1959), anterior chamber lenses (Baron 1952, Strampelli 1953) to three-piece lenses for capsular bag fixation by Pierce and Shearing in the 1970s. However it becomes obvious that already in the 1950s it was possible to correct aphakia in cases with inadequate capsular support.

Psychological characteristics, eating behavior, and quality of life assessment of obese patients undergoing weight loss interventions.

BACKGROUND AND AIMS: Bariatric surgery is the most effective treatment for obesity. However, not all patients have similar weight loss following surgery and many researchers have attributed this to different pre-operative psychological, eating behavior, or quality-of-life factors. The aim of this study was to determine whether there are any differences in these factors between patients electing to have bariatric surgery compared to less invasive non-surgical weight loss treatments, between patients choosing a particular bariatric surgery procedure, and to identify whether these factors predict weight loss after bariatric surgery. MATERIAL AND METHODS: This was a prospective study of 90 patients undergoing gastric bypass, vertical sleeve gastrectomy, or adjustable gastric banding and 36 patients undergoing pharmacotherapy or lifestyle interventions. All patients completed seven multi-factorial psychological, eating behavior, and quality-of-life questionnaires prior to choosing their weight loss treatment. Questionnaire scores, baseline body mass index, and percent weight loss at 1 year after surgical interventions were recorded. RESULTS AND CONCLUSIONS: Surgical patients were younger, had a higher body mass index, and obesity had a higher impact on their quality of life than on non-surgical patients, but they did not differ in the majority of eating behavior and psychological parameters studied. Patients opting for adjustable gastric banding surgery were more anxious, depressed, and had more problems with energy levels than those choosing vertical sleeve gastrectomy, and more work problems compared to those undergoing gastric bypass. Weight loss after bariatric surgery was predicted by pre-operative scores of dietary restraint, disinhibition, and pre-surgery energy levels. The results of this study generate a number of hypotheses that can be explored in future studies and accelerate the development of personalized weight loss treatments.

Docosahexaenoic acid (DHA) supplementation in pregnancy differentially modulates arachidonic acid and DHA status across FADS genotypes in pregnancy.

Some FADS alleles are associated with lower DHA and ARA status assessed by the relative amount of arachidonic acid (ARA) and docosahexaenoic acid (DHA) in plasma and red blood cell (RBC) phospholipids (PL). We determined two FADS single nucleotide polymorphisms (SNPs) in a cohort of pregnant women and examined the relationship of FADS1rs174533 and FADS2rs174575 to DHA and ARA status before and after supplementation with 600mg per day of DHA. The 205 pregnant women studied were randomly assigned to placebo (mixed soy and corn oil) (n=96) or 600mg algal DHA (n=109) in 3 capsules per day for the last two trimesters of pregnancy. Women homozygous for the minor allele of FADS1rs174533 (but not FADS2rs174575) had lower DHA and ARA status at baseline. At delivery, minor allele homozygotes of FADS1rs174533 in the placebo group had lower RBC-DHA compared to major-allele carriers (P=0.031), while in the DHA-supplemented group, all genotypes had higher DHA status compared to baseline (P=0.001) and status did not differ by genotype (P=0.941). Surprisingly, DHA but not the placebo decreased ARA status of minor allele homozygotes of both FADS SNPs but not major allele homozygotes at delivery. Any physiological effects of changing the DHA to ARA ratio by increasing DHA intake appears to be greater in minor allele homozygotes of some FADS SNPs.

Combined intravitreal pharmacosurgery in patients with occult choroidal neovascularization secondary to wet age-related macular degeneration.

AIM: The aim was to investigate the efficacy and safety of combined intravitreal therapy in patients with occult choroidal neovascularization (CNV) secondary to wet age-related macular degeneration (AMD) over 6 months. METHODS: In this prospective pilot study of a case series, 106 patients (mean age 75.4 years) with predominantly occult CNVs were treated with a 1.5-ml core pars plana vitrectomy with intravitreal injections of triamcinolone (8 mg), bevacizumab (1.25 mg) and balanced salt solution. The best-corrected visual acuity (BCVA; logMar), central macular thickness (optical coherence tomography), and intraocular pressure (IOP; Goldmann tonometry) were assessed at baseline and follow-up visits. RESULTS: Statistically significant increases in BCVA (vs. baseline) were observed at 2 months (mean +0.9; standard deviation +/-0.6 lines), 4 months (+1.3; +/-0.7), and 6 months (+1.2; +/-0.7) after the initial combined intravitreal therapy in 96/106 patients. At 6 months, BCVA had deteriorated in 20 of 96 (20.8%) patients by <2.5 lines, remained stable in 38 of 96 (39.6%) and improved in 31 (32.3%) patients by 1-3 lines, and in 7 (7.3%) patients by >3 lines. The mean central retinal thickness decreased by -41.2% (-195; +/-46 microm) over 6 months. 55% demanded intravitreal anti-vascular endothelial growth factor (VEGF) treatment after initial therapy. Increases in IOP were managed by eye drops in 11 (10%) patients with no other adverse event occurring. CONCLUSION: After the combined intravitreal therapy, including two drugs and a limited core vitrectomy, a significant and sustained improvement in vision of patients with occult CNVs was observed over 6 months. In 45% of the initially treated patients, anti-VEGF therapy did not have to be continued, which might be attributed to both the pharmacological effects of the drugs and the physiological changes induced by the vitrectomy (posterior vitreous detachment, liquefaction, and oxygen redistribution).

[Combined intravitreal therapy for age-related macular disease]. / Kombinierte intravitreale Therapie zur Behandlung der altersbedingten Makuladegeneration.

Since the introduction of anti-VEGF drugs for the treatmet of CNV in age-related macular degeneration (AMD), visual acuity can be stabilised or improved in a significant number of patients. There is an ongoing debate on the safety, efficiency and economic aspects related to current intravitreal therapeutic concepts. Twenty-four to 36 hours after 80 % low-fluence verteporfin photodynamic therapy (PDT) a combined phrarmacosurgical intravitreal therapy for 52 patients with wet AMD was conducted (multiple therapy). By performing a 23-gauge core vitrectomy with the Intrector, an intravitreal substitution with BSS, dexamethasone and bevacizumab was achieved via a self-adapting two-channel cannula for aspiration and injection in one probe tip. After 14 months the mean gain in visual acuity (VA) was 0.18 Snellen lines, with VA stabilisation in 14 / 52 (27 %) and VA gain in 38 / 52 (73 %) of the patients. This safe pharmacosurgical regimen indicated a low intravitreal retreatment rate of (13 / 52) 25 %.

Educational technology and the faculty role: what you don't know can hurt you.

The proliferation of teaching strategies using the Internet and other educational technology innovations has created new employment issues in higher education. The authors discuss forces influencing the increasing use of on-line instruction, factors to consider before venturing into the virtual academy, and the faculty role in shaping policy related to distributed education in their institutions and academia in general.

B- and T-cell-specific alloantigens in man.

Screening for B-cell-specific antibodies in unabsorbed pregnancy sera preselected for weak reactivity in regular HLA-A, -B, and -C screening yielded a relatively high proportion (35/81) of B-cell-specific antibodies. Most B-cell-specific antibodies react broadly, showing inclusion phenomena suggesting 'cross-reactivity' analogous to that observed in HLA-A and -B serology. In control experiments with T-cell-enriched suspensions three antisera reacted with T cells and not with B cells. These antisera are highly associated with HLA-A2 in the unrelated population and segregate with HLA haplotypes in families and with HLA-A in a family with HLA-A, B recombination, Thus it appears that the human equivalents of Ia antigens may include--in analogy to the murine Ia antigens--B cell- as well as T-cell-specific alloantigens.