Effect of Time-Restricted Eating on Weight Loss in Adults With Type 2 Diabetes: A Randomized Clinical Trial.

Importance: Time-restricted eating (TRE) has become increasingly popular, yet longer-term randomized clinical trials have not evaluated its efficacy and safety in patients with type 2 diabetes (T2D). Objective: To determine whether TRE is more effective for weight reduction and glycemic control than daily calorie restriction (CR) or a control condition in adults with T2D. Design, Setting, and Participants: This 6-month, parallel-group, randomized clinical trial was performed between January 25, 2022, and April 1, 2023, at the University of Illinois Chicago. Participants were aged 18 to 80 years with obesity and T2D. Data analysis was based on intention to treat. Interventions: Participants were randomized to 1 of 3 groups: 8-hour TRE (eating 12 to 8 pm only, without calorie counting), CR (25% energy restriction daily), or control. Main Outcomes and Measures: The primary outcome measure was change in body weight by month 6. Secondary outcomes included changes in hemoglobin A1c (HbA1c) levels and metabolic risk factors. Results: Seventy-five participants were enrolled with a mean (SD) age of 55 (12) years. The mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 39 (7) and the mean (SD) HbA1c level was 8.1% (1.6%). A total of 53 participants (71%) were women. One participant (1%) was Asian, 30 (40%) were Hispanic White, 40 (53%) were non-Hispanic Black, and 4 (5%) were non-Hispanic White. Participants in the TRE group were adherent with their eating window on a mean (SD) of 6.1 (0.8) days per week, and 17 (68%) in the CR group were adherent with their prescribed calorie goals over 6 months. The mean (SD) reduction in energy intake was -313 (509) kcal/d for TRE, -197 (426) kcal/d for CR, and -16 (439) kcal/d for controls. By month 6, body weight decreased significantly in the TRE group (-3.56% [95% CI, -5.92% to -1.20%]; P = .004) but not the CR group (-1.78% [95% CI, -3.67% to 0.11%]; P = .06), relative to controls. Levels of HbA1c decreased in the TRE (-0.91% [95% CI, -1.61% to -0.20%]) and CR (-0.94% [95% CI, -1.59% to -0.30%]) groups, relative to controls, with no differences between the TRE and CR groups. Time in euglycemic range, medication effect score, blood pressure, and plasma lipid levels did not differ among groups. No serious adverse events were reported. Conclusions and relevance: This randomized clinical trial found that a TRE diet strategy without calorie counting was effective for weight loss and lowering of HbA1c levels compared with daily calorie counting in a sample of adults with T2D. These findings will need to be confirmed by larger RCTs with longer follow-up. Trial Registration: ClinicalTrials.gov Identifier: NCT05225337.

Bio-inspired neural networks for decision-making mechanisms and neuromodulation for motor control in a differential robot.

The aim of this work is to propose bio-inspired neural networks for decision-making mechanisms and modulation of motor control of an automaton. In this work, we have adapted and applied cortical synaptic circuits, such as short-term memory circuits, winner-take-all (WTA) class competitive neural networks, modulation neural networks, and nonlinear oscillation circuits, in order to make the automaton able to avoid obstacles and explore simulated and real environments. The performance achieved by using biologically inspired neural networks to solve the task at hand is similar to that of several works mentioned in the specialized literature. Furthermore, this work contributed to bridging the fields of computational neuroscience and robotics.

Performance comparison of intraosseous devices and setups for infusion of whole blood in a cadaveric swine bone model.

OBJECTIVES: Intraosseous (IO) access can provide a critical bridge for blood product infusion when peripheral venous access is not obtainable. Successful pressurized IO infusion requires flow rates sufficient to preserve life, but with infusion pressures low enough to avoid clinical complications (e.g., hemolysis, bone damage, fat emboli). However, the optimal method for pressured IO delivery of blood was unknown. METHODS: Three trained physicians infused 500 mL of whole blood through a 15-gauge, 45 mm IO catheter into fresh, high bone density cadaveric swine proximal humeri. Participants applied eight different pressure infusion strategies: (1) gravity, (2) pressure bag, (3) pressure bag actively maintained at or above 300 mmHg, (4) hand pump, (5) hand pump with pressure bag, (6) push-pull with 10 mL syringe, (7) push-pull with 60 mL syringe, and a (8) Manual Rapid Infuser in a randomized within-subjects design (30 trials per method, 240 trials total). The primary outcomes of flow rates, mean and peak pressures, and user ratings were contrasted using ANOVA at p < 0.05. RESULTS: The Manual Rapid Infuser conferred the highest flow rates (199 ± 3 mL/min) and most favorable user ratings, but also the highest mean and peak pressures. Push-pull conferred the next highest flow rates (67 ± 5 mL/min for 60 mL, 56 ± 2 mL/min for 10 mL) and pressures, with intermediate-to-high user ratings. Hand pump flow rates were essentially identical with (45 ± 4 mL/min) or without (44 ± 3 mL/min) pressure bag, with high user ratings without a pressure bag. Pressure bag and gravity methods conferred low flow rates and user ratings. CONCLUSIONS: Some pressured IO infusion methods can achieve flow rates adequate to serve as a resuscitative bridge in the massively hemorrhaged trauma victim, but flow rates and pressures vary greatly across IO pressurized infusion methods. Manual Rapid Infuser and push-pull methods conferred high flow rates but also relatively high pressures, highlighting the importance of using in vivo models in future research to assess the possible clinical complications of using these promising methods. Combined, present findings highlight the importance of studying pressurized IO methods towards preserving the life of the critically injured trauma victim.

Implementing the Clean Clinic Approach Improves Water, Sanitation, and Hygiene Quality in Health Facilities in the Western Highlands of Guatemala.

BACKGROUND: Water, sanitation, and hygiene (WASH) services are cornerstones to providing safe health care services and improving patient satisfaction and care seeking. The Clean Clinic Approach (CCA) uses a 10-step process to support health care facilities (HCFs) in making incremental, effective cleanliness and infection prevention and control (IPC) improvements, without relying on external investments. We piloted the CCA in Guatemala and assessed the extent to which it contributed to quality improvements in WASH for IPC. METHODS: After developing an assessment tool tailored to the Guatemalan context, we assessed 11 HCFs in 8 technical areas and scored the facilities on 79 criteria with a total of 100 points. We conducted a baseline assessment (September to October 2018), second assessment (January 2019), and final assessment (February to March 2019). RESULTS: The 11 HCFs improved their average emergency/general ward scores from 41 points at baseline to 87 points at end line, based on a 100-point scale. For delivery wards, the scores increased from 50 to 91 points and for postnatal wards from 46 to 90 points. CONCLUSIONS: The CCA process and tools facilitated a systematic way for HCFs to identify, prioritize, make, and measure WASH quality of care improvements. Training facility staff was fundamental to improving quality standards, and involving medical and administration staff in joint analysis, coordination, and planning sessions was key to integration and teamwork. Further work is needed to increase involvement of local government and community members and to further adapt the process and tools.

Prescription opioid misuse among ED patients discharged with opioids.

STUDY OBJECTIVES: The purposes of this study were to determine the prevalence of prescription opioid misuse in a cohort of discharged emergency department (ED) patients who received prescription opioids and to examine factors predictive of misuse. METHODS: This prospective observational study enrolled a sample of ED patients aged 18 to 55 years who were discharged with a prescription opioid. Participants completed surveys at baseline in the ED, then 3 and 30 days later. Follow-up surveys contained questions about opioid use and misuse, including screening questions from the National Epidemiologic Survey on Alcohol and Related Conditions. Patients were categorized as misusers if they (1) self-escalated their dose, (2) obtained additional prescription opioids without a prescription, or (3) used for a reason besides pain. RESULTS: Of the 85 patients who completed follow-ups, 36 (42%) reported misuse at either 3 or 30 days. There was no difference in demographic variables, pain scores, analgesic treatment, or discharge diagnoses between misusers and nonmisusers. Self-escalation of dose was the most common category of misuse (33/36; 92%). Taking prescription opioids without a doctor's prescription was reported by 39% (14/36), and taking pain medications for a reason other than pain was reported by 36% (13/36). The presence of disability, chronic pain, preexisting prescription opioid use, oxycodone use, and past 12-month risk of substance abuse were associated with misuse. CONCLUSIONS: Prescription opioid misuse was prevalent among this cohort of ED patients. A heterogeneous mixture of behaviors was captured. Future research should focus on the etiologies of misuse with directed screening and interventions to decrease misuse.

Self-deception's adaptive value: effects of positive thinking and the winner effect.

There is a puzzle about why self-deception, a process that obscures the truth, is so pervasive in human behavior given that tracking the truth seems important for our survival and reproduction. William von Hippel and Robert Trivers argue that, despite appearances, there is good reason to think that self-deception is an adaptation by arguing: (1) self-deception leads to a positive self-perception and (2) a positive self-perception increases an individual's fitness. D.S. Neil Van Leeuwen, however, gives persuasive arguments against both steps. In response, we will defend both propositions, thereby supporting the conclusion that self-deception indeed has adaptive value. The first premise will be bolstered by a survey of the philosophical literature and empirical work on self-deception, whereas the second will be strengthened by empirical research on a behavioral phenomenon known as the winner effect.